Customer Service Representative
Company: Lucent Health Solutions LLC
Posted on: November 12, 2021
Customer Service Representatives
The Customer Service Representative (CSR) is in daily contact with
members, clients, and providers, and are very often the initial
contact with our office. The primary focus of the CSR is to answer
provider inquiries regarding verification of benefits and claims
status for benefit claims or precertification.
The CSR will work out of our Appleton, WI location for our
Nashville, Tennessee office.
Daily role responsibilities:
Handle in/outbound group health plan customer service calls;
minimum 45 calls per shift.
Answer questions concerning claims status and medical
pre-certification and explain benefit determinations.
Interpret benefit eligibility based on the client's Summary Plan
Contact providers, clients and insurance carriers as needed.
Research written and verbal inquiries in response to complex
Maintains and enters notes with details and accuracy on call log
Utilizes internal databases to provide efficient and effective
Analyzes claim and eligibility information in the LuminX
Handles competently all calls including those relating to potential
stop loss issues, TPL issues and high dollar claims.
Assesses and handle challenging callers and/or any other calls
which may need to be escalated to the manager. In the case of the
manager's absence, report to the customer service team lead.
Answers phone calls utilizing efficient interpersonal and
communication skills, as well as excellent telephone and customer
service skills and etiquette.
Maintains effective working relationships with our callers and
co-workers; always ethical, professional, courteous, and nice.
Manages time and resources efficiently and effectively, while
exhibiting a high level of attention to detail.
Participates as a Team Member to ensure the smooth operation of the
References internal and external proprietary systems to obtain
claim and eligibility information.
Performs special projects at the request of management.
Maintain up to date and thorough knowledge of employee benefit
provisions for group health plans including medical, dental, vision
and prescription drugs.
Meet the performance standards established for the position in the
areas of quality, accuracy, production, participant satisfaction
Report to work on a consistent, regular basis during core business
This position could be a good fit if you have:
1-2 years previous Health/Dental Insurance experience or experience
in medical and dental terminology, coding, and/or claims processing
Thorough understanding of Self-Funding Insurance and Third-Party
Strong organizational skills, problem solving, and decision-making
Ability to navigate through and utilize 25+ PC applications
efficiently. Knowledge in Excel and Word.
Self-direction and self-starter skills required. Demonstrated
written and oral communication skills required.
Please note this job description is not designed to cover or
contain a comprehensive listing of activities, duties or
responsibilities that are required of the employee for this job.
Duties, responsibilities, and activities may change at any time
with or without notice.
Physical and Emotional Demands:
While performing the duties of this job, the employee is frequently
required to sit. The employee is regularly required to stand; walk;
use hands to finger, handle, or feel; reach with hands and arms;
climb or balance; stoop, kneel, and talk or hear. The employee must
occasionally lift and/or move up to 10 pounds. Specific vision
abilities required by this job include close vision, distance
vision, and ability to adjust focus.
Equal Employment Opportunity Policy Statement
Lucent Health Solutions, Inc. is an Equal Opportunity Employer.
Keywords: Lucent Health Solutions LLC, Appleton , Customer Service Representative, Hospitality & Tourism , Appleton, Wisconsin
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