Claims Processor

Job Title

Pay Range: $20hr - $22hr

Requirement/Must Have

• High School diploma or equivalent work experience.
• 3+ years of data entry experience.
• Strong customer service focus.
• Strong verbal and written communication skills.
• Able to multi-task and prioritize issues.
• Strong attention to details.

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.
• Coordinates and completes 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.

Nice to Have

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