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Claims Examiner

A72298ea 3808 4935 A1ac 07d4d323bbbc 19000101 000001 · Clifton, NJ, US, Clifton, NJ · On Site · Deleted · $70,000–$80,000 / year · ADP Workforce Now Recruiting

Job facts

FieldValue
CompanyA72298ea 3808 4935 A1ac 07d4d323bbbc 19000101 000001
TitleClaims Examiner
Normalized title-
Department / team-
LocationClifton, NJ, United States
Work modelOn Site
Employment typeFull Time
Salary$70,000–$80,000 / year
Statusdeleted
ATS providerADP Workforce Now Recruiting
Posted / first seen2026-05-26 / 2026-05-31
Changed / last seen2026-06-06 / 2026-06-05

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PageWhat it containsOpen
Company jobsActive postings from A72298ea 3808 4935 A1ac 07d4d323bbbc 19000101 000001.Open
Company breakdownsRole, location, ATS, and work model facets for this company.Open
ATS provider jobsActive postings observed through ADP Workforce Now Recruiting.Open
Provider filtered searchThe same provider as a filtered job collection.Open
City jobsActive postings in Clifton.Open
Work model jobsActive On Site postings.Open
Lifecycle eventsOpen, update, close, and reopen events for this posting.Open
Original postingCanonical source or apply URL captured from the ATS.Open

Linked records

CompanyA72298ea 3808 4935 A1ac 07d4d323bbbc 19000101 000001
Source1ece3aba-036a-4bd7-8215-79f22d333265
ATS providerADP Workforce Now Recruiting

Description

The Claims Examiner – Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight. This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week. Key Responsibilities Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules Process complex or high-dollar claims requiring supervisory overrides Distribute daily claim workloads and support operational workflow efficiency Prepare and maintain documentation for internal and external audits Ensure compliance with prompt pay regulations and timely filing requirements Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions Analyze remittance advice (EOBs/ERAs) and communicate findings as needed Support monthly claims reporting and departmental performance tracking Collaborate with leadership to meet monthly productivity and accuracy goals Respond promptly and professionally to internal and external communications Perform additional duties as assigned to support claims operations and leadership initiatives Required Qualifications: 5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care Strong knowledge of Medicaid and Medicare claim processing Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules Experience with electronic claims submission, clearinghouses, and billing resubmission processes In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards Familiarity with appeals and reconsideration processes for government payers Experience researching and resolving claim denials and timely filing issues Working knowledge of AS400 or similar claims processing systems Intermediate to advanced Microsoft Office skills, with emphasis on Excel Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment Preferred Qualifications: Previous leadership experience would be preferred Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB) Prior experience in vision plans, optometry, ophthalmology, or eye care billing Experience supporting or participating in claims audits or compliance reviews Why Join Us? Be part of a collaborative claim’s leadership-focused environment Opportunity to specialize in eye care and vision insurance claims Role offers stability, growth, and exposure to complex adjudication and compliance work National Vision Administrators For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health & Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today's health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey. Website: http://www.e-nva.com We are an equal opportunity employer Monday - Friday 8:30am - 5:00pm

Full job record

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Org ID3ab3629a-8f34-4df0-a98b-e63bd0f1f5a7
Source ID1ece3aba-036a-4bd7-8215-79f22d333265
Board ID1ece3aba-036a-4bd7-8215-79f22d333265
Provideradp_workforcenow
Provider Job Key591909
TitleClaims Examiner
Normalized Title—
Statusdeleted
Activeno
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Department—
Team—
Employment Typefull_time
Workplace Typeon_site
Remote Policy—
CountryUnited States
RegionNJ
CityClifton
Salary Raw70000.00 To 80000.00 (USD) Annually
Salary Min70,000
Salary Max80,000
Salary CurrencyUSD
Salary Periodyear
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First Seen At2026-05-31 18:21:27Z
Last Seen At2026-06-05 02:45:17Z
Last Checked At2026-06-06 20:16:10Z
Last Changed At2026-06-06 20:16:10Z
Inactive At2026-06-06 20:16:10Z
Source Posted At2026-05-26 15:14:00Z
Source Updated At—
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    "requisitionDescription": "<div><div><div><div><div><div><p data-pasted=\"true\"><span style=\"white-space:pre;\">&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;' data-pasted=\"true\"><span style=\"font-size: 16px; font-family: arial, sans-serif;\">The Claims Examiner &ndash; Vision Insurance is a key contributor within the Claims Department, responsible for accurately adjudicating vision and eye care claims in compliance with Medicaid, Medicare, and commercial payer guidelines. This role supports operational excellence by ensuring timely payments, regulatory compliance, and high-quality service to providers and internal stakeholders. The Claims Examiner plays an active role in meeting departmental performance metrics and supporting audits, reporting, and workflow oversight.</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><br></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:13.8pt;font-size:16px;font-family:\"Aptos\",sans-serif;background:white;' data-pasted=\"true\"><span style=\"font-size: 16px; font-family: arial, sans-serif; color: rgb(38, 35, 33);\">This is a fully on-site role, and employees are expected to report to the Clifton, New Jersey office five days per week.</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><br></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><strong>Key Responsibilities</strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Review, evaluate, and adjudicate vision and eye care insurance claims in accordance with payer guidelines, including Medicaid, Medicare, and Coordination of Benefits (COB) rules</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Process complex or high-dollar claims requiring supervisory overrides</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Distribute daily claim workloads and support operational workflow efficiency</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Prepare and maintain documentation for internal and external audits</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Ensure compliance with prompt pay regulations and timely filing requirements</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Research and resolve rejected, denied, or pending claims, including billing corrections and resubmissions</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Analyze remittance advice (EOBs/ERAs) and communicate findings as needed</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Support monthly claims reporting and departmental performance tracking</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Collaborate with leadership to meet monthly productivity and accuracy goals</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Respond promptly and professionally to internal and external communications</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Perform additional duties as assigned to support claims operations and leadership initiatives</li></ul><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><br></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><strong>Required Qualifications:</strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">5+ years of experience adjudicating and processing healthcare claims, preferably in vision insurance or eye care</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Strong knowledge of Medicaid and Medicare claim processing</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Proficiency with CPT, ICD-10, HCPCS codes, and modifiers, including billing and coding edits</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Solid understanding of Third-Party Liability (TPL) and Coordination of Benefits (COB) rules</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Experience with electronic claims submission, clearinghouses, and billing resubmission processes</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">In-depth knowledge of HCFA-1500 (CMS-1500) and electronic billing standards</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Familiarity with appeals and reconsideration processes for government payers</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Experience researching and resolving claim denials and timely filing issues</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Working knowledge of AS400 or similar claims processing systems</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Intermediate to advanced Microsoft Office skills, with emphasis on Excel</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Strong attention to detail, analytical skills, and ability to manage deadlines in a high-volume environment</li></ul><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><br></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><strong>Preferred Qualifications:</strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Previous leadership experience would be preferred&nbsp;</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Certified Professional Coder (CPC/CBC) and/or Certified Professional Biller (CPB)</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Prior experience in vision plans, optometry, ophthalmology, or eye care billing</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Experience supporting or participating in claims audits or compliance reviews</li></ul><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><br></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:0in;margin-left:0in;line-height:115%;font-size:16px;font-family:\"Aptos\",sans-serif;'><span style=\"font-size: 16px; font-family: arial, sans-serif;\"><strong>Why Join Us?</strong></span></p><ul style=\"margin-bottom:0in;margin-top:0in;\" type=\"disc\"><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Be part of a collaborative claim&rsquo;s leadership-focused environment</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Opportunity to specialize in eye care and vision insurance claims</li><li style=\"margin: 0in; line-height: 115%; font-size: 16px; font-family: arial, sans-serif;\">Role offers stability, growth, and exposure to complex adjudication and compliance work</li></ul><p><br></p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;background:white;' data-pasted=\"true\"><span style='font-size:15px;font-family:\"Arial\",sans-serif;color:#262321;'>National Vision Administrators</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;background:white;'><span style='font-size:15px;font-family:\"Arial\",sans-serif;color:#262321;'>For over 40 years, National Vision Administrators (NVA) has been meeting the vision benefit needs of public employer groups, Health &amp; Welfare Funds, Associations and Coalitions. Providing millions of people throughout the United States with vision care programs that help them be smarter buyers of eye care and eyewear, NVA is particularly well suited to address today&#39;s health benefit challenges as it relates to eye care. We offer cost-effective, customized vision benefit programs that are clinically integrated. We are proud of the fact that we have retained over 99% of our clients and believe it is the greatest testimony to the high-quality benefits and service satisfaction we provide to both our clients and their members. Headquartered in Clifton, New Jersey.</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;background:white;'><span style='font-size:15px;font-family:\"Arial\",sans-serif;color:#262321;'>Website:&nbsp;</span><span style=\"color:black;\"><a href=\"http://www.e-nva.com/\" target=\"_blank\"><span style='font-size:15px;font-family:\"Arial\",sans-serif;color:#324FA5;'>http://www.e-nva.com</span></a></span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:16px;font-family:\"Aptos\",sans-serif;background:white;'><span style='font-size:15px;font-family:\"Arial\",sans-serif;color:#262321;'>We are an equal opportunity employer</span></p></div></div></div></div></div></div>\n<br/>Monday - Friday 8:30am - 5:00pm",
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    "requisitionTitle": "Claims Examiner ",
    "clientRequisitionID": "2306",
    "organizationalUnits": [],
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    "additionalProperties": {},
    "requisitionLocations": [
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}
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