Claims Analyst

Lucent Health Solutions Inc
US - Wisconsin - Appleton
October 21, 2024

About Lucent Health

Lucent Health 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 smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

Company Culture

We believe that the success of Lucent Health relies on having employees who are honest, ethical and hardworking. These values are the foundation of Lucent Health.

Honest
Transparent Communication: be open and clear in all interactions without withholding crucial information
Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
Truthfulness: provide honest feedback and report any issues or challenges as they arise
Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior
Ethical Fair Decision Making: ensure all actions and decisions respect company policies and values
Accountability: own up to mistakes and take responsibility for rectifying them
Respect: treat colleagues, clients and partners with fairness and dignity
Confidentiality: safeguard sensitive information and avoid conflicts of interest
Hardworking Consistency: meet or exceed deadlines, maintaining high productivity levels
Proactiveness: take initiative to tackle challenges without waiting to be asked
Willingness: voluntarily offer to assist in additional projects or tasks when needed
Adaptability: work efficiently under pressure or in changing environments
Summary

The purpose of the Claims Analyst is to provide exceptional customer service. Claims Analysts process medical, dental, disability, pharmacy, and flexible spending claims in a timely and accurate manner. Claims Analysts are the primary contact for our groups and members in answering claims questions and resolving issues. The analyst is also responsible for performing check runs for their groups.

Job Responsibilities Report to work during core business hours (8:00 a.m. - 5:00 p.m.) on a consistent, regular basis
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
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.
Maintain a positive and professional attitude.
Work with members of staff on identifying process improvements
Flexibility to work overtime as dictated by department/company needs.
Perform other duties as assigned by management.
Qualifications 1-2 years previous claims experience.
Claims pricing (Network, Medicare, RBP (Ref. Based Pricing) 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.
Self-directed and starter skills required.
Working hours: 8:00AM to 5:00PM M-Th, Friday 8:00AM to 4:00PM.
Demonstrated written and oral communication skills required.

Equal Employment Opportunity Policy Statement

Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.

Read the full job description and apply online on the recuiter's web-site

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