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 Claims Analyst is a key member of LHS Claims Administration team for our Wisconsin office and works collaboratively with claims administration, client services, account management and check run for Lucent Health client groups. The claims analyst is responsible to provide exceptional customer service and resolution for groups, members and providers; process medical, dental, disability, pharmacy, and flexible spending claims and check runs in a timely and accurate manner. This Lucent Health professional has working knowledge of coding structures; claims pricing and claims processing, the ability to efficiently multi-task and prioritize to successfully perform the essential duties and responsibilities of this career opportunity. The ideal candidate will have a relevant understanding of third party administrators, working knowledge of healthcare medical/dental/pharmacy/flexible spending or vision claims, daily servicing of client requests via email and telephone contacts, experience in receiving and interpreting data, entering of information into the benefits claims processing system and check runs. Other duties as assigned.
Essential Duties and 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.
- 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.
- Meet productivity and adhere to expectations determined by the claims department.
- Report to work during core business hours (8:00 a.m. – 5:00 p.m.) on a consistent, regular basis.
- Duties as assigned by management.
- 1-2 years previous health insurance 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.
Work Authorization/Security Clearance: Must be a U.S. Citizen or possess authorized credentials as required by the U.S. Citizenship and Immigration Services.
Measures of Performance: The Claims Analyst shall be performing in an acceptable manner when the following have been accomplished:
1. Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
2. Customer Service – Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
3. Analytical Thinking – Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Makes a systematic comparison of two or more alternatives; Notices discrepancies and inconsistencies in available information; Approaches a complex task or problem by breaking it down into its component parts and considering each part in detail; Weighs the cost, benefits, risks, and chances for success in making a decision; Designs work flows and procedures.
4. Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
5. Oral Communication – Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Tailors the content of speech to the level and experience of the audience; Uses appropriate grammar and choice of words in oral speech; Organizes ideas clearly in oral speech; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
6. Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
7. Teamwork – Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed; Listens and responds constructively to other team members’ ideas; Offers support for others’ ideas and proposals; Is open with other team members about his/her concerns; Expresses disagreement constructively.
8. Quality Management – Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
- Ethics – Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
- Judgment – Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
11. Quantity – Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly.
12. Attendance/Punctuality – Is consistently at work and on time; Ensures work responsibilities are shared with supervisor when absent.
13. Dependability – Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals. Completes tasks on time or notifies appropriate person with an alternate plan.
Physical and Emotional Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The inability to cope with a stressful work environment does not constitute a protected disability.
While performing the duties of this job, the employee is frequently required to sit. The employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, and talk or hear. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually very quiet.
Position Type/Expected Hours of Work: Occasional flexible hours may be allowed, but the employee must be available during the “core” work hours of 8:00 a.m. to 5:00 p.m. and must work a minimum of 40 hours each week to maintain full-time status. Evening and weekend work may be required as job duties demand.
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.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.