Processor III, Claims
SEE how you can make a difference! Be part of an innovative company that cares about its associates and helps members enjoy the wonders of sight through healthy eyes and vision.
Versant Health provides vision care to 37 million members nationwide! To ensure your continued success we provide opportunities for advancement and development.
Our associates remain engaged through a comprehensive compensation and benefits package which includes health and dental insurance, tuition reimbursements, 401(k) with company match, pet insurance and FREE vision insurance for you and your family
Scope and Purpose of Position:
The Claims Processor III enters claims into the CompuVision/CVX system for adjudication and payment. This role consistently meets production and quality standards and is responsible for prepping, scanning and performing a quality check of incoming claims received for processing. The Claims Processor III also enters data in Formworks or vertex service information from scanned images into the MACESS Claim Management System.
Essential Functions:
- Processes all claim submissions for adjudication and payment
- Meets required performance guarantee deadlines, company objectives and production and quality standards
- Investigates open authorizations and questionable claims and/or services
- Researches claim payment discrepancies
- Adheres to privacy and confidential and proprietary company policies and procedures (i.e. HIPAA)
- Participates in any/all training and educational activities necessary to fulfill at least the minimum requirements as specified within your departmental goals. This is in addition to, the completion of any activities necessary for the maintenance of professional affiliations or organizational requirements
- Diligently maintains the cleanliness of all equipment, workstations and the overall facility on a daily basis
- Perform data entry and coding in Formworks
- Prepare documents
- Perform vertex verification in Entrendex
- Review output images for overall quality
- As required by changing business needs, completes additional responsibilities as assigned
- Regular reliable attendance is required
- Career opportunity with additional training in skills for higher level position (i.e. imaging, data entry, claims processor) which will be considered minimal qualifications should open positions become available
Education and Experience:
- Minimum High School Diploma or GED
- One year of insurance claims processing experience required
HIPAA & Security Requirements
All 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.
We take pride in our recruiting process and follow a merit-based employee recruitment practice with extensive screening steps. We will never request money from candidates who seek employment with us and will never ask for any payment as part of the recruitment process.
We provide equal employment opportunities (EEO) to all associates and applicants for employment without regard to race, color, religious beliefs, age, sex (including pregnancy), sexual orientation, gender identity or expression (including transgender status), national origin, ancestry, status as a protected veteran or disabled veteran, physical or mental disability or history of disability, genetic information, marital status, or any and all other categories protected by under applicable Federal, state or local law.
This policy extends to all associates and to all aspects of the employment relationship. Any associate who