We are looking for more smart, talented, passionate, loyal, and fun-loving individuals to become "Lucent Health" - the face, the voice, and the behavior that represents the quality of who we are to those we serve!
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.
Essential duties and 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.
- 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 Solutions, Inc. is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, creed, color, religion, alienage or national origin, ancestry, citizenship status, age, disability or handicap, sex, marital status, veteran status, sexual orientation, genetic information, gender identity, gender expression, transgender status, arrest record, or any other characteristic protected by applicable federal, state or local laws. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.