Resolution Case Specialist

3 days ago


Nashville, Tennessee, United States Lucent Health Solutions LLC Full time
Job Overview

We are seeking a highly skilled Resolution Case Specialist - Claims Processor to join our team at Lucent Health Solutions LLC.

This role involves investigating escalated issues, communicating with stakeholders, and providing exceptional customer service. The ideal candidate will have excellent communication skills, be able to work in a fast-paced environment, and possess a strong attention to detail.

Estimated Salary: $50,000 - $65,000 per year

Key Responsibilities
  • Investigate escalated issues within a timely fashion to ensure 7-10 day turnaround.
  • Communicate with Senior Claims Analyst, Account Management, and Customer Service Manager to ensure proper handling of issues.
  • Call all members back within 24 hours of escalation.
  • Claims processing knowledge.
  • Answer phone calls utilizing efficient interpersonal and communication skills, as well as excellent telephone and customer service skills and etiquette, as needed and during high call volume.
  • Exhibit an attention to detail.
  • Exhibit a strong work ethic.
  • Be organized and able to manage time and resources efficiently and effectively.
  • Able to maintain effective working relationships with our callers and co-workers; always ethical, professional, and courteous.
  • Participate as a Team Member to ensure the smooth operation of the entire department.
  • Maintain and enter notes with details and accuracy on call log tracking application.
  • Maintain production goals regarding the number of cases received and closed.
  • Enter case information into the Resolution Database to keep team informed of status of issues.
  • Complete other projects as assigned.
  • Handles competently all cases including those relating, but not limited to potential stop loss issues, TPL issues, high dollar claims, vendor/network disputes.
  • Comply with company policies and procedures as outlined in the Employee Handbook.
  • Comply with department policies and procedures.
  • Assist in training other employees at the manager's request.
  • Perform special projects at the request of management.
  • Regular, predictable attendance is required.
  • Ability to get along and work effectively with others.


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