Claims Specialist
4 days ago
We are seeking a skilled Claims Analyst to join our team at Lucent Health Solutions LLC. The successful candidate will be responsible for processing medical, dental, disability, pharmacy, and flexible spending claims, as well as certifying the check run process in a timely and accurate manner.
The ideal candidate will possess strong analytical skills, the ability to navigate multiple PC applications, and excellent organizational and problem-solving skills. Previous experience in claims processing, medical coding, or billing is preferred.
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 as well as 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.
- Maintain a positive and professional attitude.
- Meet quality and production requirements and adhere to expectations determined by the claims department.
Requirements
- High School Diploma / GED (or higher)
- Strong analytical skill set: must have the ability 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.
- 1+ years of experience in a related environment, claims processing, medical coding, or billing preferred.
- Working hours: 8:00AM to 5:00PM M-Th, Friday 8:00AM to 4:00PM.
- Demonstrated written and oral communication skills required.
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