Healthcare admin with EyeMed experience

Company Description

US IT Solution

Job Description

Maintain proper internal controls and risk management with respect to the membership processing & reconciliation, billing, and claims processing.

Maintain the integrity of membership data in the EyeMed eligibility system.

Maintain a working knowledge of EyeMed systems that include the claims and eligibility system, Metastorm, and constituent facing systems (Exclaim, eyeNET, member web, Call Center interface).

Effectively manage client initiatives including:

o Overall management and execution of specific client operational projects: define scope, create project timeline with defined key deliverables, complete business requirements, drive resolution of non-standard requests, and communicate status of outstanding issues to EyeMed /Client leadership teams.

o Provide complete and timely communication and reporting to manager related to client projects in process.

o Comply with standards of administration as defined by functional areas. Responsible for meeting deadlines as defined by clients and various functional areas.

Drive client satisfaction:

o Lead the post-implementation operational support of operations issue resolution.

o Analyze, report and drive for resolution of membership, billing, and claims processing trends with the goal of improving effectiveness.

o Participate in client meetings to ensure understanding of client needs and provide operational guidance.

Drive Key Performance Indicators:

o Ensure client operational changes are implemented for cross functional and client satisfaction.

o Ensure backup plans are developed and implemented to effectively respond to unplanned situations within standards.

Qualifications

Bachelor's Degree or equivalent experience 

Additional Information

All your information will be kept confidential according to EEO guidelines.