Coordinator- Claims

Requisition :944725

Store #:110365 EM Claims Processing - OH CSC

Position:Full-Time

Total Rewards:

Benefits/Incentive Information

At Eye Med, 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 One Sight Essilor Luxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world's vision crisis.

Eye Med is part of Essilor Luxottica, 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 Linked In.

The Claims Coordinator will accurately and efficiently process all types of manual claims. The Coordinator will process complex claims, which includes coordination of benefits claims, Medically Necessary claims, resubmitted claims, Eye Route claims, standard adjustments, VIP claims, complex manual workaround processes, claims rework projects, and daily reporting processes while ensuring key deliverables are met.

• Efficiently and accurately processes complex claims
• Consistently achieves key performance indicators with respect to production, cycle time, and quality
• Participates on claims project initiatives, including rework and/or payment integrity efforts
• Understands and quickly operationalizes process changes resulting from new plans, benefit designs, regulatory changes, etc.
• Works with manager and co-workers to provide strong customer service and communication with key customer interfaces that include:
  Eye Med Account Managers, Operations, IT, Client Representatives and Eye Med leadership team
• Frequent communication with internal associates and claims management. Ensure upward and downward communication to keep management and team members properly informed.
• Consistently meets or exceeds agreed upon performance standards in both productivity and accuracy.
• Proactively works with supervisor to develop self-remediation plan when standards are not being met.

• High School diploma or equivalent work experience
• 3+ year(s) of data entry experience
• Knowledge and experience in Microsoft Office Products (Outlook, Word, Excel)
• Ability to work well under pressure and multi-task
• Flexibility working in both a team and individual environments
• Ability to quickly grasp and retain information and concepts

• Bachelor's degree
• Claims processing experience
• Strong customer service focus
• Good verbal & written communication skills
• Able to quickly grasp and retain information and concepts
• Able to multi-task and prioritize issues
• Strong attention to details
• Knowledge of Medicare/Medicaid business
• Understand and honor high level of confidentiality
• Knowledge of vision benefits and/or insurance industry
• Working knowledge of interface systems that include: claims data entry processing system (Facets), workflow tools (Filebound and Eye Route).