Claims Specialist

7 hours ago


Appleton, Wisconsin, United States Lucent Health Solutions, Inc. Full time

About Lucent Health Solutions, Inc.

Luent Health Solutions, Inc. combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make informed, cost-effective healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time.

Job Responsibilities

  1. Process medical claims, dental claims, disability claims, pharmacy claims, and flexible spending claims in a timely and accurate manner.
  2. Interpret and apply specific plan document language as well as determine eligibility for benefits during claims adjudication.
  3. Provide written correspondence and verbal information to members, group contacts, agents, and healthcare providers.
  4. Refer potential abuse, subrogation, and adjustment claims.
  5. Perform necessary check run process and communicate check register information.
  6. Provide responsive and professional customer service for assigned groups as well as other groups with Cypress as needed.

Requirements

  • 1-2 years previous claims experience.
  • Claims pricing (Network, Medicare, RBP experience.
  • Coding structures, CPT, HCPCS, Revenue codes, ICD 9/10, etc. experience or certification required.
  • Strong understanding of claims analyst process and procedures skills.
  • Thorough understanding of Self-Funding and Third-Party Administrating concepts.
  • Ability to navigate through and utilize various PC applications efficiently.
  • Strong organizational skills, problem solving, and decision-making skills required.

Lucent Health Solutions, Inc. is an Equal Opportunity Employer



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