Claims Processor III
: Job Details :

Posted Friday, September 27, 2024 at 4:00 AMClaims Processor IIIWho are we?Versant Health is one of the nation's leading administrators of managed vision care, serving millions of our clients' members nationwide. We are driven by our mission to help members enjoy the wonders of sight through healthyeyes and vision.As a Versant Health associate, you can enjoy a comprehensive Total Rewards package, which includes health and dental insurance, tuition reimbursement, 401(k) with company match, pet insurance, no-cost-to-you vision insurance for you and your qualified dependents. We are also invested in your success. There are many opportunities for advancement and development throughout all stages of your career with us.See how you can make a difference with the support of strong leadership and a team environment.See Everything, Be Anything.What are we looking for?The Claims Processor III role is responsible for processing claims in the CompuVision/CVX system(s) and supports claims routing and handling in the MACESS Claims Management System workflows. The position is also responsible for incoming paper claims received for processing to include entering data in Formworks using the three modules (OCR, KFI, and KE) to pass claims to the MACESS Claim Management System and/or CompuVision/CVX. The role handles assigned claims-related inventories including but not limited to claim adjustments, claims reconciliations, and claim issue research/resolution. All established production and quality metrics must be met when completing assigned responsibilities.Where you will have an impactPerforms data entry and verification of incoming paper claimsProcesses all claim submissions for adjudication and paymentResearch and resolves claim discrepancies utilizing business knowledge, training, and internal guidelinesSupports other departments concerning claims related questionsMeets required performance guarantee deadlines, company objectives and production and quality standardsAdheres to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)Participates in training and educational activities necessary to meet the requirements of the position to include production and quality standards and department goalsCompletes any activities necessary for the maintenance of professional affiliations or organizational requirementsRegular reliable attendance is requiredOther duties as assignedWhat's necessary to do the job?Minimum High School Diploma or GEDOne year of claims experience requiredKnowledge of International Classification of Diseases (ICD) and/or Current Procedural Terminology (CPT) codes requiredProficiency in Microsoft OfficeHIPAA & Security RequirementsAll Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.Versant Health will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.Versant Health is a proud Equal Employment Opportunity and Affirmative Action employer dedicated to attracting, retaining, and developing a diverse and inclusive workforce. All qualified applicants will receive consideration for employment at Versant Health without regards to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, age, disability, national origin, marital or domestic/civil partnership status, genetic information, citizenship status, uniformed service member or veteran status, or any other characteristic protected by law.The wage range for applicants for this position is [$20.50].All incentives and benefits are subject to the applicable plan terms.#J-18808-Ljbffr