Claims Specialist

Requisition ID: 894344 
Store # : 110365 EM Claims Processing - OH CSC 
Position: Full-Time
Total Rewards:  Benefits/Incentive Information

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.

 Our mission is to help people see life to the fullest—and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world’s vision crisis.

EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

GENERAL FUNCTION

The Specialist - Claims is responsible for providing claims subject matter expertise within the department to ensure all managed vision claims are processed timely and accurately. The Specialist will report to the claims manager/supervisor and will assist with executing department goals to ensure key performance measures are met.

MAJOR DUTIES AND RESPONSIBILITIES

• Provide support in managing daily work activities to ensure successful and timely processing of managed vision care claims
• Provide subject matter expertise regarding claim processing functions, directly supporting the claims department.
• Assist in monitoring daily claims inventory, and proactively resolving production issues.
• Coordinate and ensure completion of claim corrections.
• Maintain claim processing standards, policies and desk level procedures to ensure appropriate key performance measures are met.
• Evaluate, recommend, and update department standard operating procedures and best practices, to drive improvement with claims processors/coordinators accuracy and efficiency.
• Assist the team manager/supervisor with training and new employee onboarding activities.
• Maintain effective, on-going communication with department team members and management to ensure all stakeholders are properly informed.
• Support department projects and/or production functions as needed, ensuring production and quality performance standards are met.
• Ensure compliance and understanding of all policies, SLAs, procedures, protocols, compliance and security guidelines/regulations. 

BASIC QUALIFICATIONS

• High School Diploma
• 3+ years of data entry experience
• Claims processing experience
• Knowledge of vision benefits and/or insurance industry
• Working knowledge of Microsoft Office Products (Outlook, Word, Excel)
• Excellent communication, problem solving, teamwork and time & task management skills

PREFERRED QUALIFICATIONS

• Bachelor's degree
• Knowledge of Medicare/Medicaid business
• Working knowledge of Facets
• Strong customer service focus

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

EssilorLuxottica complies with all applicable laws related to the application and hiring process. If you would like to provide feedback regarding an active job posting, or if you are an individual with a disability who would like to request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name, job id number, and contact information so that we may follow up in a timely manner) or email [email protected] .

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.