Claims Coordinator

Requisition ID: 875945 
Store #: E02209 Admin-Operations-General VA000 
Position:Full-Time
Total Rewards: Benefits/Incentive Information

Vision Associates is the nation’s leading optical dispensary management & consulting company. Our mission is provide the highest level of service and integrity. Our extensive background in the optical industry enables us to provide solutions that promote growth and profitability. In partnership with our clients', our foremost objective is to deliver complete and comprehensive service that reflects our commitment to eye care excellence.

Everyday we feel inspired to ignite our passion for patient care. Our people work closely with doctors, learn from complex medical cases, and make a difference in patients' lives. We unleash the power of optical.

Vision Associates is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of ophthalmic lenses, frames and sunglasses.

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GENERAL FUNCTION

The Claims Coordinator will accurately and efficiently process all types of manual claims.  The Coordinator will process complex claims, which includes coordination of benefits claims, Medically Necessary claims, resubmitted claims, EyeRoute claims, standard adjustments, VIP claims, complex manual workaround processes, claims rework projects, and daily reporting processes while ensuring key deliverables are met.

MAJOR DUTIES AND RESPONSIBILITIES

• Efficiently and accurately processes complex claims
• Consistently achieves key performance indicators with respect to production, cycle time, and quality
• Participates on claims project initiatives, including rework and/or payment integrity efforts
• Understands and quickly operationalizes process changes resulting from new plans, benefit designs, regulatory changes, etc.
• Works with manager and co-workers to provide strong customer service and communication with key customer interfaces that include: EyeMed Account Managers, Operations, IT, Client Representatives and EyeMed leadership team
• Frequent communication with internal associates and claims management. Ensure upward and downward communication to keep management and team members properly informed.
• 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.

BASIC QUALIFICATIONS

• High School diploma or equivalent work experience
• 3+ year(s) of data entry experience
• Knowledge and experience in Microsoft Office Products (Outlook, Word, Excel)
• Ability to work well under pressure and multi-task
• Flexibility working in both a team and individual environments
• Ability to quickly grasp and retain information and concepts

PREFERRED QUALIFICATIONS

• Bachelor's degree
• Claims processing experience
• Strong customer service focus
• Good verbal & written communication skills
• Able to quickly grasp and retain information and concepts
• Able to multi-task and prioritize issues
• Strong attention to details
• Knowledge of Medicare/Medicaid business
• Understand and honor high level of confidentiality
• Knowledge of vision benefits and/or insurance industry
• Working knowledge of interface systems that include: claims data entry processing system (Facets), workflow tools (Filebound and EyeRoute).

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. 
 
Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process.  To request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 ( (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com. 
  
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.