Customer Service Representative

Customer Service Representative
Full-Time
Department: Operations - Member Services
Appleton, WI (In-Office)
Role 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 Description/Core Responsibilities and Duties:

• 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.

Requirements:
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.
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.

Supervisory Responsibilities: This job has no supervisory duties.
Salary Range: $17- $19/hour
Equal Employment Opportunity Policy Statement: Lucent Health Solutions, Inc. is an Equal Opportunity Employer.