Processor- Claims

EssilorLuxottica Group•Mason, OH

3d•Onsite

About The Position

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use. Our mission is to help people see life to the fullest—and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis. EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

Requirements

High School diploma or equivalent work experience
1+ year(s) of data entry experience

Nice To Haves

Bachelor's degree
Claims processing experience
Strong customer service focus
Good verbal communication skills
Good written communication skills
Able to quickly grasp and retain information and concepts
Able to multi-task and prioritize issues
Strong attention to detail
Knowledge of Medicare/Medicaid business
Understand and honor high level of confidentiality
Knowledge of vision benefits and/or insurance industry
Proficient in Microsoft Word, Excel and Access
Working knowledge of interface systems such as Facets, EyeNet, and ExClaim

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.
Effectively and accurately reviews images and transcribed data in the Vidado portal in preparation for auto adjudication.
Participates on special project initiatives, including rework efforts as needed.
Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
Maintains compliance with HIPAA guidelines and regulations.
Works with supervisor and co-workers to provide a high standard of customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
Partners with the Provider Relations team by providing information that is necessary to properly train the stores, providers and field management.
Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.