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