Claims Examiner

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:

Government Claims Processor/Examiners are a key part of the department’s successful operation. Processor/Examiners are in daily contact with team members, clients and providers. This position reports to the Supervisor, Government Operations. A cheerful, competent and compassionate attitude will directly impact the productivity of the team. Attendance can also directly impact the satisfaction level of our clients and retention of our accounts.

Responsibilities:

• Process claims accurately, efficiently and within production requirements
• Exhibit an attention to detail and a strong work ethic
• Ability to access research tools for accurate claims entry
• Be organized and able to manage time and resources efficiently and effectively
• Thorough knowledge of coding structures (CPT, HCPCS, Rev codes, ICD 9/10 etc)
• Ability to perform arithmetic calculations
• Knowledgeable of COB
• Familiarity with benefits and benefit calculations
• Ability to handle many types of claims pricing (Network, Medicare, UCR etc)
• Performs duties in a HIPAA compliant manner
• Participate as a Team Member to ensure the smooth operation of the entire department
• Maintain guidelines and notes with detail to enable accurate claims examination
• Maintain production goals regarding the number of claims entered and accuracy percentages.

Qualifications:

• Proficient in the use of desktop computer software.
• Excellent communication via written, telephonic and personal
• Ability to manage and follow through consistently and accurately
• Attention to detail
• Completion of all responsibilities in a timely manner
• Highly organized work habits

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.