Claims Processor

Position Overview

We are seeking detail-oriented Claims Specialists / Claims Processors to accurately and efficiently process manual claims, adjustments, and other basic claims-related activities.

In this role, you will process standard, non-complex claims while meeting established productivity, quality, and turnaround-time expectations. The ideal candidate has strong data-entry skills, excellent attention to detail, a customer-service mindset, and the ability to manage multiple priorities in a fast-paced environment.

Key Responsibilities

• Process standard claims and claim adjustments accurately and efficiently.
• Apply established processing procedures and basic claims-adjudication knowledge.
• Meet or exceed productivity, cycle-time, and quality standards.
• Quickly learn and apply processing changes related to new plans and benefit designs.
• Participate in non-complex special claims projects and network initiatives as assigned.
• Provide professional customer service and clear communication to internal and external business partners.
• Collaborate with supervisors and coworkers to support client satisfaction.
• Work with EyeMed Account Managers, Operations, Information Systems, Client Representatives, and leadership teams as needed.
• Monitor individual performance and proactively partner with supervisors to create a remediation plan when performance standards are not met.
• Maintain accurate records and complete data-entry activities in accordance with established procedures.
• Follow company policies, remote-work requirements, and information-security protocols.

Required Qualifications

• 0–1 year of experience in claims processing, data entry, healthcare administration, insurance, or a related field.
• Strong data-entry skills and attention to detail.
• Basic knowledge of claims processing, third-party benefits, or benefits administration.
• Working knowledge of personal computers and spreadsheet applications.
• Basic proficiency with Microsoft Excel and Microsoft Access.
• Strong customer-service and communication skills.
• Ability to work well under pressure and manage multiple tasks.
• Ability to consistently meet productivity, accuracy, and quality goals.
• Strong organizational skills and a willingness to learn new systems and processes.
• Data-entry test scores must be included on the resume for consideration.

Preferred Qualifications

• Experience with claims or benefits-processing systems.
• Familiarity with systems such as EyeMed, Metastorm, Exclaim, or EyeNet.
• Experience processing health, vision, insurance, or employee-benefit claims.
• Previous experience working in a high-volume administrative or data-entry environment.

Work Environment

This is a hybrid position based in Mason, Ohio, with an expectation of working in the office 2–3 days per week. Remote work requires an appropriate home-workspace setup and compliance with all applicable company remote-work protocols.

Additional Information

• Background check and OIG/GSA exclusion screenings are required.
• This is a contract-to-hire opportunity with potential for permanent employment based on business needs and performance.
• Candidates must be able to work the full Monday–Friday schedule, including a 30-minute lunch period.

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