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Claims Processing Specialist

1 month ago

Appleton, Wisconsin, United States Lucent Health Solutions LLC Full time

We are seeking a skilled Claims Processing Specialist to join our team at Lucent Health Solutions LLC.

About the Role:

In this role, you will be responsible for processing medical and/or dental claims, as well as disability, pharmacy, flexible spending, or vision claims, if applicable. You will interpret and apply specific plan document language to determine eligibility for benefits during claims adjudication.

You will work collaboratively with claims administration, client services, account management and check run for Lucent Health client groups to provide written correspondence and verbal information to members, external and internal group contacts, agents, and healthcare providers.

As a Claims Processing Specialist, you will also refer potential abuse, subrogation, and adjustment claims, perform necessary check run process, and communicate check register information. You will maintain a positive and professional attitude, meet quality and production requirements, and adhere to expectations determined by the claims department.

Key Responsibilities:

  • Process medical and/or dental claims, as well as disability, pharmacy, flexible spending, or vision claims, if applicable.
  • Interpret and apply specific plan document language to determine eligibility for benefits during claims adjudication.
  • Work collaboratively with claims administration, client services, account management and check run for Lucent Health client groups.
  • Provide written correspondence and verbal information to members, external and internal group contacts, agents, and healthcare providers.
  • Refer potential abuse, subrogation, and adjustment claims.
  • Perform necessary check run process and communicate check register information.

Required Skills and Qualifications:

  • Bachelor's degree in a related field (e.g., healthcare administration, business, or finance).
  • Minimum 1 year of experience in claims processing, medical coding, or billing.
  • Strong analytical skill set to identify and solve discrepancies.
  • Ability to navigate through and utilize 25+ PC applications efficiently.
  • Strong organizational skills, problem-solving, and decision-making skills required.
  • Self-directed and starter skills required.

Benefits:

  • Average annual salary: $65,000 - $85,000 based on experience and location.
  • Holiday pay, sick leave, and other standard employee benefits.
  • Opportunities for professional growth and development within the company.

We value our employees' contributions and offer a supportive work environment that fosters collaboration and innovation. If you're a detail-oriented and results-driven individual looking for a challenging role, we encourage you to apply.