Job Summary:
The Vision Claim Processor is responsible for the accurate and efficient filing of vision care claims. This includes reviewing and filing claims in a timely and accurate manner through to resolution (payment/contractual adjustment), resolves standard and complex claims, and providing support to customers and healthcare providers regarding claim statuses and insurance benefits.
Key Roles and Responsibilities:
? Claim Processing:
o Review and file vision care claims in accordance with company policies and procedures.
o Verify the accuracy of claim submissions, including patient information, service dates, and procedure codes.
o Assess claims to determine coverage based on the patient?s vision care insurance plan.
o Ensure claims are processed correctly and in a timely manner.
? Documentation and Record-Keeping:
o Maintain accurate and up-to-date records of processed claims.
o Document any discrepancies, issues, or observations during the claim processing phase.
o Ensure compliance with federal and state regulations regarding privacy and record-keeping.
o Customer Service: Provide exceptional customer service to both healthcare providers and policyholders.
o Respond to inquiries and resolve issues related to claims, benefits, and policy coverage.
o Guide policyholders and providers through the claims process, clarifying insurance benefits and procedures as needed.
? Coordination and Collaboration:
o Collaborate with other departments, such as customer service and policy management, to ensure a seamless experience for policyholders.
o Work closely with healthcare providers to obtain necessary documentation or clarification on claims.
o Participate in team meetings and training sessions to stay updated on policy changes and procedural updates.
? Quality Assurance:
o Perform quality checks on processed claims to ensure accuracy and compliance.
o Identify patterns of discrepancies or common issues and report them to management for process improvement.
o Participate in audits and reviews as required.