Customer Service Representative

Job Description

Job Description

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 Customer (Member) Service Representatives is a key part of the company’s successful operation. The Member Service Representative is in daily contact with members, clients and providers, and are very often the initial contact with our office.

A cheerful, competent and compassionate attitude will directly impact the satisfaction level of our clients and retention of our accounts.

Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.

Job Responsibilities :

• Handle incoming and outbound group health plan customer service calls. Minimum calls per shift 45
• Answer questions concerning claims status and medical pre-certification
• Interpret benefit eligibility based on the client's Summary Plan Description (SPD)
• Explain benefit determinations
• Contact providers, clients and insurance carriers as needed
• Research written and verbal inquiries in response to complex customer calls
• Answers phone calls utilizing efficient interpersonal and communication skills, as well as excellent telephone and customer service skills and etiquette
• Manages time and resources efficiently, while exhibiting a high level of attention to detail.
• Maintains effective relationships with our callers and co-workers; always ethical, professional, courteous, and nice
• Participates as a Team Member to ensure the smooth operation of the entire department
• References internal and external proprietary systems to obtain claim and eligibility information
• Maintains and enters notes with details and accuracy on call log tracking application
• Utilizes internal databases to provide efficient and effective information
• Analyzes claim and eligibility information in the LuminX system
• Handles competently all calls including those relating to potential stop loss issues, TPL issues and high dollar claims
• Assesses and handle challenging callers and / or any other calls which may need to be escalated to the manager. In the case of the manager’s absence, report to the customer service team lead
• Complies with company and department policies and procedures
• Performs special projects at the request of management
• Regular, predictable attendance is required.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 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.

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.