Sr. Claims Analyst

Requisition ID:886341

Store #:113001 EM Payments - OH CSC

Position:Full-Time

Total Rewards:Benefits/Incentive Information

At EyeMed, we have a unique perspective on vision benefits. By listening and staying curious, we create innovative vision benefits that are a joy to use.

Our mission is to help people see life to the fullest-and our commitment goes beyond vision benefits. Our passionate employees proudly support the OneSight EssilorLuxottica Foundation, a leading not-for-profit organization with a 100% focus on eradicating the world's vision crisis.

EyeMed is part of EssilorLuxottica, a global leader in the design, manufacture and distribution of world-class vision care products, including iconic eyewear, advanced lens technology and cutting-edge digital solutions. Join our global community of over 200,000 dedicated employees around the world in driving the transformation of the eyewear and eyecare industry. Discover more by following us on LinkedIn.

GENERAL FUNCTION

The Sr Analyst, Claims Testing is responsible for the complete claims validation for client testing requests, new client implementations and system stability testing. The Sr Analyst with be the liaison to Claims Testing Manager, Director Claims & Payments and other internal customers to identify claims processing discrepancies due to system setup issues that require cross functional partnership and retesting.

MAJOR DUTIES AND RESPONSIBILITIES

• Collaborate and partner with cross functional departments to define testing scope and prioritization of testing requests.
• Develop and maintain testing scenario spreadsheets.
• Work with cross functional departments to ensure system is ready for testing scenarios to be keyed.
• Validate the integrity of claims data in the EyeMed claims and payments UAT systems.
• Track all testing defects and the status of the defect resolution through re-testing.
• Partner with IT and other departments to identify system changes/tickets that may need entered into the system
• Conduct End to End testing, Be the Constituent testing, and Pre-Implementation testing.
• Lead testing and issue resolution processes including cross-functional communication and IT partnership to identify concerns, create action plans to solve and ensure testing is meeting the needs of our constituents (plans, members and providers).
• Analyze and document clear and concise testing results so there is a smooth transition to EyeMed's claims and payments production systems.
• Maintain effective, on-going communication with Claims Testing Manager and other key departments.
• Understand the process flow of systems, how the systems interact and the logic behind file requirements (SAP, ODS and Facets / EOBs/RAs)
• Identify opportunities for improvement related to the testing process and best practices. Sees these opportunities through implementation.
• Report any potential risks to the Claims Testing Manager related to testing.

BASIC QUALIFICATIONS

• Bachelor's Degree or equivalent work experience
• 3+ years of experience in Claims or Data processing / testing
• Knowledge of PCs and spreadsheet applications
• Working knowledge of Facets / SAP / Business Objects / complex systems
• Strong communication, problem solving, teamwork and organization skills
• Strong analytical skills and critical thinking
• Ability to work cross functionally
• Ability to multitask and manage project timelines
• 3+ years of process management

PREFERRED QUALIFICATIONS

• Bachelor's Degree in IT related field or Analytics
• 5+ years of analysis experience
• Knowledge of SQL
• Highly motivated self-starter
• 5+ years of process management

Employee pay is determined by multiple factors, including geography, experience, qualifications, skills and local minimum wage requirements. In addition, you may also be offered a competitive bonus and/or commission plan, which complements a first-class total rewards package. Benefits may include health care, retirement savings, paid time off/vacation, and various employee discounts.

Upon request and consistent with applicable laws, EssilorLuxottica will provide reasonable accommodations to individuals with disabilities who need assistance in the application and hiring process. To request a reasonable accommodation, please call the EssilorLuxottica SpeakUp Hotline at 844-303-0229 (be sure to provide your name and contact information so that we may follow up in a timely manner) or email HRCompliance@luxotticaretail.com.

We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, gender, national origin, social origin, social condition, being perceived as a victim of domestic violence, sexual aggression or stalking, religion, age, disability, sexual orientation, gender identity or expression, citizenship, ancestry, veteran or military status, marital status, pregnancy (including unlawful discrimination on the basis of a legally protected pregnancy or maternity leave), genetic information or any other characteristics protected by law. Native Americans in the US receive preference in accordance with Tribal Law.