Claims Processor

Claims Processor

Location: 4000 Luxottica Place Mason Oh 45040

Hybrid opportunity with 3 days office and 2 days remote

Compensation: $22.55/hr on W2

Schedule: Full-time (8h day / 40 week). Standard 9am-5pm

Contract Length: 5 months of contract, extension possible depending on the performance and business need

Start date: ASAP

General Function

The Claims Coordinator accurately and efficiently processes all types of claims from source documents, maintaining compliance with the insurance plan requirements and with high regard for adhering to goals for quality and claims production rates. Also performs other complex claim processing which include but not limited to Medicare/Medicaid Pend process, Corrected Claims, and running daily reports.

Major Duties and 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.
• Coordinate and complete 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.

Basic Qualifications

High School diploma or equivalent work experience

3+ year(s) of data entry experience

Strong customer service focus

Strong verbal & written communication skills

Able to multi-task and prioritize issues

Strong attention to details

Preferred Qualifications

Knowledge of Medicare/Medicaid business

Knowledge of vision benefits and/or insurance industry

Proficient in Microsoft Word, Excel and Access