Vision Insurance Claims Specialist

EyeMed Vision Care; Mason (OH); On-site; USD 38,000 - 52,000; Full time

Job summary

EyeMed Vision Care in Mason, OH seeks a full-time Claims Processor to accurately process a variety of vision insurance claims and adjustments, ensuring compliance with plan requirements and quality targets. The role emphasizes data entry, review of claims, HIPAA compliance, and collaboration with Account Managers, Operations, and client teams to deliver reliable customer service.

Experience with Vidado portal and familiarity with benefits designs is a plus.

Qualifications

• High School diploma or equivalent work experience.
• 1+ year of data entry experience.
• Knowledge of Medicare/Medicaid business.
• Experience in vision benefits or insurance industry is a plus.
• Proficient in Microsoft Word, Excel and Access.
• Strong attention to detail and ability to maintain confidentiality.

Responsibilities

• Efficiently and accurately processes a variety of vision insurance claims or adjustments.
• Determines any special plan requirements prior to billing.
• Reviews claims before entry for completeness and compliance with business requirements.
• Reviews images and transcribed data in the Vidado portal for auto adjudication preparation.
• Participates on special project initiatives and rework efforts as needed.
• Operates processing changes from new plans and benefit designs.
• Maintains HIPAA compliance and protects confidential information.
• Collaborates with Account Managers, Operations, IS, Client Representatives and leadership.
• Provides information to Train stores, providers and field management.
• Contacts stores or providers to obtain additional information or follow up on claims.

Skills

Attention to detail

Verbal communication

Written communication

Multi-tasking

Prioritization

Customer service

Grasp new information

Confidentiality

Medicare/Medicaid knowledge

Education

High School diploma or equivalent

Bachelor's degree

Tools

Microsoft Word

Microsoft Excel

Access

Facets

EyeNet

ExClaim

Job description

EyeMed Vision Care in Mason, OH seeks a full-time Claims Processor to accurately process a variety of vision insurance claims and adjustments, ensuring compliance with plan requirements and quality targets. The role emphasizes data entry, review of claims, HIPAA compliance, and collaboration with Account Managers, Operations, and client teams to deliver reliable customer service.

Experience with Vidado portal and familiarity with benefits designs is a plus.