Provider Relations Representative Job Description

(Customer Service Representative)

Role Summary

The primary focus of the Provider Relations Representative is to answer provider inquiries regarding verification of benefits and claims status for medical and dental claims; entering precertification’s into the claims processing system, working miscellaneous claims queues, sending out correspondence, outbound provider call projects, and reviewing claims spreadsheets and plan documents.

Daily role responsibilities:

  • Works collaboratively with claims administration for Lucent Health client groups. 
  • Provide responsive and professional customer service to providers regarding status of medical and dental claims.
  • Utilize necessary resources and navigate systems efficiently to accurately verify eligibility and provide verification of benefits.
  • Assist providers in getting set up and utilizing Provider Portal
  • Maintain a positive and professional attitude.
  • Work with members of staff on identifying process improvements
  • Perform other duties as assigned by management.
  • Report to work on a consistent, regular basis during core business hours (8:00 a.m. – 5:00 p.m.).

This position could be a good fit if you have:

  • 1-2 years previous Health/Dental Insurance experience or experience in medical and dental terminology, coding, and/or claims processing preferred.
  • Thorough understanding of Self-Funding Insurance and Third-Party Administrating concepts.
  • Strong organizational skills, problem solving, and decision-making skills required.
  • Ability to navigate through and utilize 25+ PC applications efficiently. Knowledge in Excel and Word.
  • Self-direction and self-starter skills required. Demonstrated written and oral communication skills required.

Other Duties

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.

Physical and Emotional Demands:

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.

Apply here: https://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=e1915ed5-02ec-41dc-bdad-58bcfdf7caef&ccId=19000101_000001&lang=en_US&jobId=9200119542636_1&source=EN

Equal Employment Opportunity Policy Statement

Lucent Health Solutions, Inc. is an Equal Opportunity Employer.