Claims Coordinator

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: client Account Managers, Operations, IT, Client Representatives and client 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).

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