Claims Processor

Job Title

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.