Job title: Claims Analyst

Company: Lucent Health Solutions LLC

Job description: 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! *

Next training class start date: November 1st 2021!

Claims Analyst Job Description

Role Summary

The primary focus of 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.

Daily role responsibilities:

  • Works collaboratively with claims administration, client services, account management and check run for Lucent Health client groups.
  • 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 Lucent 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.

This position could be a good fit if you have:

  • 1-2 years previous health insurance claims experience. Working knowledge of coding structures; claims pricing and claims processing.
  • 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 25+ 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.

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.

Equal Employment Opportunity Policy Statement

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


Expected salary:

Location: Appleton, WI

Job date: Thu, 23 Sep 2021 07:56:53 GMT

Apply for the job now!