Specialist - Customer Service (Intake QA)

Requisition ID: 901314 
Store # : 113004 EM Payment Integrity - 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 Intake Specialist-QA Ops is responsible for the intake and triage of member and provider complaints/appeals as well as client inquiries for case research.

MAJOR DUTIES AND RESPONSIBILITIES

• Completes logging of all Grievance and Appeal activity from members, providers and clients through all channels (email, ticketing system, mail).
• Enters all case details into the case management tool (Facets) including dates, provider, member, claim and/or client facts relevant to the case.
• Categorizes cases based on submission source, delegation requirements, request type and contracted timelines.
• Intakes and logs new client delegation and SLA requirements in Facets to enable timely case processing for the team.
• Continually reviews the team inbox throughout the day to ensure urgent issues are logged in a timely manner and submissions are redirected to other departments as needed.
• Communicates with internal and external stakeholders during the initial intake of new cases.
• Generates acknowledgment letters for delegated member and provider complaints and appeals according to contracted SLAs.
• Assigns delegated cases to Resolution Specialists using a rotating method where each new case is assigned to the next person in the list, cycling through the group in order, to ensure an equitable distribution of workload over time.
• Escalates trends to leadership of incorrect submissions or processing errors for coaching to improve overall department quality.
• Meets established quality and productivity standards in all areas of complaints and appeals, including client performance guarantees and all applicable state and federal regulations.

BASIC QUALIFICATIONS

• High school diploma
• Working knowledge of Microsoft Outlook
• 2+ years claims processing or medical/vision benefits and product experience
• High level of professionalism and ability to deal with sensitive information
• Strong oral and written communication skills
• Ability to work well under pressure and multi-task
• High sense of urgency and ability to manage to strict deadlines
• Ability to work independently

PREFERRED QUALIFICATIONS

• Bachelor’s degree in Business related discipline
• Working knowledge of interface systems including Cura, Facets and Exclaim
• 3+ years claims processing or medical/vision benefits and product experience
• Industry experience in insurance complaint and appeal resolution
• Specific software, industry, previous role experience

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.