Claims Supervisor
Benecard Services Inc.
Summary
National Vision Administrators is seeking an experienced Claims Supervisor to oversee daily operations of the vision eye care claims team. This role ensures accurate and timely Medicaid and Medicare claims adjudication, while maintaining compliance with regulatory requirements and company standards.
Job description
Key Responsibilities
- Supervise claims staff and manage daily workflow
- Review and process complex and high-dollar claims
- Ensure accuracy of medical billing and coding (CPT, ICD-10, HCPCS, modifiers)
- Manage COB/TPL claims and resolve denials/rejections
- Ensure Prompt Pay compliance and regulatory adherence
- Oversee ManageEngine tickets and escalations
- Support audits, reporting, and quality assurance initiatives
- Train and develop team members
Qualifications
- 3+ years of Medicaid/Medicare insurance claims processing and adjudication experience is required
- Prior experience in vision plans, optometry, ophthalmology, or eye care billing is required
- Strong knowledge of CPT, ICD-10, HCPCS, modifiers
- Strong knowledge of CMS-1500 (HCFA 1500) forms and electronic billing
- Strong knowledge of timely filing, resubmissions, appeals, and remittance advice
- Experience with COB/TPL and denied claims resolution
- Familiarity with AS400 or similar claims systems
- Strong Excel and Microsoft Office skills
- Excellent communication and organizational skills
- CPC, CPB, or CBC certification is preferred
Requirements
- 3+ years of Medicaid/Medicare insurance claims processing and adjudication experience is required
- Prior experience in vision plans, optometry, ophthalmology, or eye care billing is required
- Strong knowledge of CPT, ICD-10, HCPCS, modifiers
- Strong knowledge of CMS-1500 (HCFA 1500) forms and electronic billing
- Strong knowledge of timely filing, resubmissions, appeals, and remittance advice
- Experience with COB/TPL and denied claims resolution
- Familiarity with AS400 or similar claims systems
- Strong Excel and Microsoft Office skills
- Excellent communication and organizational skills
- CPC, CPB, or CBC certification is preferred
Benefits
- Vacation and Sick/Personal Time
- Medical, Dental, Vision
- Hearing Program Discount
- Short- & Long-Term Disability
- Life Insurance
- Flexible Spending Account
- 401(k) with company match
- Employee Referral Program
- Employee Recognition
- Tuition Reimbursement
- Professional Development Training
Company overview
Benecard Services Inc., operating as Benecard Services LLC, is a premier nationwide prescription benefit administrator founded in 1990 and headquartered in Lawrenceville, New Jersey. The company specializes in administering carve-out, fixed-rate insured prescription drug benefit programs for both private and public sector organizations. As a full-service, in-house prescription benefit administrator, Benecard provides comprehensive solutions that include mail and specialty drug dispensing services. The company distinguishes itself through its unique guaranteed cost model, offering clients predictable Rx budgets with maximum cost protection. With regional locations in Ohio, Connecticut, and Pennsylvania, Benecard serves organizations ranging from 100 to 5,000+ members, delivering tailored benefit programs that incorporate cost control measures and clinical solutions to maximize member adherence and safety while ensuring ease of administration for plan sponsors.