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Claims Specialist

mindlanceMason, OH

2 days ago

Occupations

Insurance Claims and Policy Processing ClerksClaims Adjusters, Examiners, and InvestigatorsMedical Records Specialists

Industries

Claims AdjustingPharmacy Benefit Management and Other Third Party Administration of Insurance and Pension FundsAll Other Insurance Related Activities
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About the role

GENERAL FUNCTION: Accurately and efficiently processes manual claims and other simple processes such as claims projects. Through demonstrated experience and knowledge, process standard, non-complex claims requiring a basic knowledge of claims adjudication.
MAJOR DUTIES & 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 Indications - 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 metKNOWLEDGE & SKILLS:
  • Data entry and claims processing knowledge
  • Has a working knowledge of interface systems that include the EyeMed claims system, Metastorm, Exclaim and EyeNet
  • 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-taskEXPERIENCE:0-1 years of claims processing/data entry experience. Knowledge of PCs and spreadsheet applications

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JOB OVERVIEW

Experience level

Junior

Location

Mason, OH

Occupation

Insurance Claims and Policy Processing Clerks

Industry

Claims Adjusting

Posted

2 days ago

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