Claims Examiner II
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 position requires the ability to work in a high volume claims environment including daily processing of various types of claims. The Claims Examiner II is responsible for reviewing correcting and releasing claims in the appropriate claim system for payment. The Claims Examiner II will review and release an average of at least 250 claims every day. Claims Examiner II accuracy will be no less than 98%, with a claim goal completion minimum of 95%.
Essential Functions
- Processing of various types of claims.
- Processing of Priority Claims and Member Pays Claim.
- Handling of claim edit issues.
- Back-up for the Claims Examiner I when needed.
Education & Experience
- High School Diploma or equivalent required. AA in business or equivalent preferred.
- Three plus years claims processing (medical, dental and/or vision) is required.
- Knowledge of provider reimbursements and experience in the vision insurance industry would be preferred.
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 violates this policy will be subject to disciplinary action up to and including termination.
