Claims Processor

CLAIMS PROCESSOR

Budgeted Bill rate: $25.00


MARKUP 33.05% / Tenure discount 13 months 22.50%


Payment Terms - Net 90 (paid when paid)


EYEMED Background check & 5-panel drug screening required before start date.


HYBRID - 2-3x in Mason Office.


Duration: unknown - Pending Extension


Data Entry Test Scores required on Resumes. If not received, the resume will be declined.


Hours: M-F/Full-Time; 8-4:30 (30-Minute lunch)


Must have adequate WFH space and follow all Luxottica remote protocol.


A $ 2,000.00 missing equipment fee is assessed if equipment is not returned.


GENERAL FUNCTION: Accurately and efficiently processes manual claims and other simple processes such as claims projects. Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication.

MAJOR DUTIES & RESPONSIBILITIES:

• Processing - Efficiently and accurately processes standard claims or adjustments
• Consistently achieves key internals with respect to production, cycle time, and quality
• May participate on non-complex special claims projects initiatives, including network efforts
• Understands and quickly operationalizes processing changes resulting from new plans, benefit designs.
• Drive client satisfaction - Works with supervisor and co-workers to provide strong customer service and communication with key customer interfaces that include EyeMed Account Managers, Operations, Information Systems, Client Representatives and EyeMed leadership team
• Drives Key Performance Indications - 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

KNOWLEDGE & SKILLS:

• Data entry and claims processing knowledge
• Has a working knowledge of interface systems that include the EyeMed claims system, Metastorm, Exclaim and EyeNet
• Some basic working knowledge of software programs, specifically Excel and Access
• Understands third party benefits and administration
• Strong customer service focus
• Ability to work well under pressure and multi-task

EXPERIENCE:


0-1 years of claims processing/data entry experience. Knowledge of PCs and spreadsheet applications


EDUCATION: High school mandatory


There will actually be 5 courses that required for all temporary employees:


3 for Compliance purposes and 2 for HiTrust / Security requirements:

1. General Compliance


2. HIPAA


3. Fraud, Waste, and Abuse


4. Security Essentials


5. Introduction to Phishing