Clinical Claims Specialist

5 days ago


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

Job Summary:

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We are seeking a skilled Clinical Claims Specialist to join our team at Lucent Health Solutions LLC. As a Clinical Claims Specialist, you will play a vital role in processing medical and dental claims, as well as disability, pharmacy, flexible spending, and vision claims.

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About the Role:

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You will be responsible for interpreting and applying 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 teams to ensure seamless claim resolution.

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Key Responsibilities:

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  • Claims Processing: Process medical and/or dental claims, as well as disability, pharmacy, flexible spending, or vision claims, if applicable.">
  • Claim Resolution: Provide written correspondence and verbal information to members, external and internal group contacts, agents, and healthcare providers to resolve claims efficiently.">
  • Abuse and Adjustment Claims: Refer potential abuse, subrogation, and adjustment claims for further review and action.">
  • Check Run Process: Perform necessary check run process and communicate check register information to relevant parties.">
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Requirements:

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  • Education: High School Diploma / GED (or higher)">
  • Experience: 1+ years of experience in a related environment, claims processing, medical coding, or billing preferred">
  • Skills: Strong analytical skill set, ability to navigate through and utilize multiple PC applications, strong organizational skills, problem-solving, and decision-making skills required">
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Work Environment:

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This is a hybrid role, with flexibility to work from either Nashville TN or Appleton WI offices. The ideal candidate will have excellent communication skills, be self-directed, and possess a positive attitude.

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Salary Range:

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$55,000 - $65,000 per year, depending on experience.

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Benefits:

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Luent Health Solutions LLC offers a comprehensive benefits package, including health insurance, retirement savings plan, paid time off, and opportunities for professional growth and development.



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