OH/ Claims Processor
Location: Mason, Ohio
Posted: December 17, 2016
Reference ID: 178731423
Claims Processor General Function:
• Accurately and efficiently processes manual claims and other simple processes such as matrix and bypass.
• Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication.
MAJOR DUTIES AND 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 Indicators - 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 AND SKILLS: Data entry and claims processing knowledge.
• 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.
• 1 year of claims processing/data entry experience.
• Knowledge of PCs and spreadsheet applications.