Customer Service Representative- Hybrid

Job DescriptionJob Description

Customer Service Representative

Full-Time, Hybrid- Nashville TN or Appleton WI

Lucent Health is seeking full time Customer Service Representatives, bilingual individuals .

The Customer 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.

Essential Duties and Responsibilities: include the following. Other duties may be assigned.

• Handle incoming and outbound group health plan customer service calls
• Provide e-Payables support to various providers as well as cross-sell them on the benefits
• Answer questions concerning claims status, medical pre-certification and e-Payment
• Interpret benefit eligibility based on Summary Plan Descriptions
• 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.
• Exhibits attention to detail and a strong work ethic.
• Manages time and resources efficiently and effectively.
• Maintains effective working relationships with our callers and co-workers; always ethical, professional and courteous.
• 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.
• Answers a minimum of 76 calls per shift.
• Utilizes internal databases to provide efficient and effective information.
• Analyzes claim and eligibility information using the Trizetto 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.

Education and/or Experience:

One to two years’ experience and/or training in a call center environment, ideally in a health insurance environment; or

equivalent combination of education and experience. Knowledge of medical terminology, system hierarchies, medical

coding, and claims processing are a plus

Qualifications:

• Detail-oriented with strong organizational skills.
• Excellent telephone etiquette and interpersonal skills.
• Excellent oral communication skills and written communication skills, Spanish-speaking individuals .
• Strong skills in MS Word, Excel, and Outlook. Trizetto system a plus.
• Professional demeanor with ability to work in a fast-paced environment.
• Must also be able to work independently, multi-task, have excellent attention to detail, and be a team player