Maintain proper internal controls and risk management with respect to the membership processing & reconciliation, billing, and claims processing.
Maintain the integrity of membership data in the EyeMed eligibility system.
Maintain a working knowledge of EyeMed systems that include the claims and eligibility system, Metastorm, and constituent facing systems (Exclaim, eyeNET, member web, Call Center interface).
Effectively manage client initiatives including:
o Overall management and execution of specific client operational projects: define scope, create project timeline with defined key deliverables, complete business requirements, drive resolution of non-standard requests, and communicate status of outstanding issues to EyeMed /Client leadership teams.
o Provide complete and timely communication and reporting to manager related to client projects in process.
o Comply with standards of administration as defined by functional areas. Responsible for meeting deadlines as defined by clients and various functional areas.
Drive client satisfaction:
o Lead the post-implementation operational support of operations issue resolution.
o Analyze, report and drive for resolution of membership, billing, and claims processing trends with the goal of improving effectiveness.
o Participate in client meetings to ensure understanding of client needs and provide operational guidance.
Drive Key Performance Indicators:
o Ensure client operational changes are implemented for cross functional and client satisfaction.
o Ensure backup plans are developed and implemented to effectively respond to unplanned situations within standards.
Bachelor's Degree or equivalent experience
All your information will be kept confidential according to EEO guidelines.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
We are from US IT Solutions, an ISO Certified, E-Verify, WMBE Certified organization established in 2005 in CA. O ur company is serving various State, Local and County Departments for over 10 years. USITSOL has been helping clients innovate across all phases of the application lifecycle for over a decade. Some of our prestigious clients are State of CA, State of OR, State of FL, State of NC, State of GA, State of CO, State of VA, State of AR, State of MI, State of OH, State of IL, State of MO, State of MS, California State University, Sacramento Area Sanitation Department, SMUD, Sound Transit, LA Superior Courts, District of Columbia, UMAS, University of Central Florida and Hennepin County and many more.