Claims Specialist

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