Claims Supervisor 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. In-office onsite 5 days a week in Clifton New Jersey - Monday-Friday 8:30am-5:00pmKey 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, modifiersCMS-1500 (HCFA 1500) forms and electronic billing
- 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 skillsCPC, CPB, or CBC certification is preferred
- Company Benefits
- Vacation and Sick/Personal Time
- Medical Insurance / Prescription / Vision / Dental
- Hearing Program Discount
- Short- & Long-Term Disability Insurance
- Life Insurance
- Flexible Spending Account 401(k) plus company match
- Employee Referral Program
- Employee Recognition
- Tuition Reimbursement
- Professional Development Training
- 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.
