Claims Specialist
7 hours ago
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
- Process medical claims, dental claims, disability claims, pharmacy claims, and flexible spending claims in a timely and accurate manner.
- Interpret and apply specific plan document language as well as determine eligibility for benefits during claims adjudication.
- Provide written correspondence and verbal information to members, group contacts, agents, and healthcare providers.
- Refer potential abuse, subrogation, and adjustment claims.
- Perform necessary check run process and communicate check register information.
- 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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