Claims Processor

Cynet Systems•Mason, OH

4d•Onsite

About The Position

The Claims Processor will efficiently and accurately process a variety of vision insurance claims or adjustments. This role involves determining special plan requirements prior to billing, reviewing claims for completeness and compliance, and preparing them for auto adjudication. The processor will also handle claim error corrections, maintain the Medicare/Medicaid Pend Claims process, and participate in special projects. Understanding and implementing processing changes due to new plans and benefit designs is crucial. The position requires maintaining HIPAA compliance and collaborating with internal teams and external clients to provide excellent customer service. Additionally, the role may involve assisting the Team Lead in a backup capacity and performing root cause analysis of claim issues. Contacting stores or providers for claim-related information may also be necessary.

Requirements

High School diploma or equivalent work experience.
3+ years of data entry experience.
Strong customer service focus.
Strong verbal and written communication skills.
Ability to multi-task and prioritize issues.
Strong attention to details.
Data Entry.
Claims Processing.
HIPAA Compliance.
Microsoft Word.
Microsoft Excel.
Microsoft Access.
Customer Service.
Root Cause Analysis.

Nice To Haves

Knowledge of Medicare/Medicaid business.
Knowledge of vision benefits and/or insurance industry.
Proficient in Microsoft Word, Excel and Access.

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 portal in preparation for auto adjudication.
Coordinate and complete claim error corrections.
Maintains the Medicare/Medicaid Pend Claims process.
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 strong customer service and communication with key customer interfaces that include Account Managers, Operations, Information Systems, Client Representatives and leadership team.
Assists Team Lead in a backup lead capacity.
Assists with root cause analysis of claim issues to resolve thoroughly and completely for clients.
Contacts stores or providers (when necessary) to obtain additional information or follow up on claims.