Claims Processor

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 met

KNOWLEDGE & 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-task
EXPERIENCE:
0-1 years of claims processing/data entry experience. Knowledge of PCs and spreadsheet applications