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Customer Service Representative

2 months ago

San Francisco, United States Lucent Health Solutions, Inc. Full time
Customer Service Representative

Full-Time, Hybrid

Rancho Cordova, CA, US

Lucent Health, in Rancho Cordova, is seeking full time Customer Service Representatives, bilingual individuals preferred.

The Customer Service Representative is in daily contact with members, clients, and providers, and are very often the initial

contact with our office. A cheerful, competent and compassionate attitude will directly impact the satisfaction level of our

clients and retention of our accounts.

Essential Duties and Responsibilities: include the following. Other duties may be assigned.
  • Handle incoming and outbound group health plan customer service calls
  • Provide e-Payables support to various providers as well as cross-sell them on the benefits
  • Answer questions concerning claims status, medical pre-certification and e-Payment
  • Interpret benefit eligibility based on Summary Plan Descriptions
  • Explain benefit determinations
  • Contact providers, clients and insurance carriers as needed
  • Research written and verbal inquiries in response to complex customer calls
  • Answers phone calls utilizing efficient interpersonal and communication skills, as well as excellent telephone and customer service skills and etiquette.
  • Exhibits attention to detail and a strong work ethic.
  • Manages time and resources efficiently and effectively.
  • Maintains effective working relationships with our callers and co-workers; always ethical, professional and courteous.
  • 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.
  • Maintains and enters notes with details and accuracy on call log tracking application.
  • Answers a minimum of 76 calls per shift.
  • Utilizes internal databases to provide efficient and effective information.
  • Analyzes claim and eligibility information using the Trizetto 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 managers absence, report to the customer service team lead.
Education and/or Experience:

One to two years experience and/or training in a call center environment, ideally in a health insurance environment; or

equivalent combination of education and experience. Knowledge of medical terminology, system hierarchies, medical

coding, and claims processing are a plus

Qualifications:
  • Detail-oriented with strong organizational skills.
  • Excellent telephone etiquette and interpersonal skills.
  • Excellent oral communication skills and written communication skills, Spanish-speaking individuals preferred.
  • Strong skills in MS Word, Excel, and Outlook. Trizetto system a plus.
  • Professional demeanor with ability to work in a fast-paced environment.
  • Must also be able to work independently, multi-task, have excellent attention to detail, and be a team player