Health Insurance Customer Service Representative

3 weeks ago


Appleton, Wisconsin, United States Lucent Health Full time
Job Summary

The Provider Relations Representative plays a vital role in ensuring seamless interactions between healthcare providers and Lucent Health's client groups. This position requires a high level of professionalism, attention to detail, and excellent communication skills.

Key Responsibilities
  • Respond to provider inquiries regarding claim status and benefits verification in a timely and professional manner.
  • Enter precertifications into the claims processing system and manage miscellaneous claims queues.
  • Send correspondence and participate in outbound provider call projects.
  • Review claims spreadsheets and plan documents to ensure accuracy and compliance.
  • Collaborate with claims administration to resolve provider issues and improve processes.
Requirements
  • 1-2 years of experience in health insurance, medical terminology, coding, or claims processing.
  • Thorough understanding of self-funding insurance and third-party administration concepts.
  • Strong organizational, problem-solving, and decision-making skills.
  • Ability to navigate multiple PC applications efficiently, with proficiency in Excel and Word.
  • Self-direction and self-starter skills, with excellent written and oral communication skills.
Physical and Emotional Demands

This role requires frequent sitting, with occasional standing, walking, and use of hands to perform tasks. The employee must be able to lift and move up to 10 pounds. Specific vision abilities required include close vision, distance vision, and ability to adjust focus.



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