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Customer Service Representative

Company: Lucent Health Solutions LLC
Location: Appleton
Posted on: November 12, 2021

Job Description:

Customer Service Representatives
Role Summary:
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 Description (SPD).
Contact providers, clients and insurance carriers as needed.
Research written and verbal inquiries in response to complex customer calls.
Maintains and enters notes with details and accuracy on call log tracking application.
Utilizes internal databases to provide efficient and effective information.
Analyzes claim and eligibility information in the LuminX system.
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 entire department.
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 and attendance.
Report to work on a consistent, regular basis during core business hours.
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 preferred.
Thorough understanding of Self-Funding Insurance and Third-Party Administrating concepts.
Strong organizational skills, problem solving, and decision-making skills required.
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.
Other Duties
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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