What are the responsibilities and job description for the Customer Service Resolution Specialist position at Lucent Health Solutions LLC?

Job Description

Hybrid : Nashville TN or Appleton WI

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 Resolution Representative is a key part of the department’s successful operation. The Resolution Representative is in daily contact with members, clients, providers, as well as internal teams / departments and is very often a critical contact within our office. A cheerful, positive, competent and compassionate attitude will directly impact the satisfaction level of our clients and retention of our accounts.

Responsibilities :

Investigates escalated issues within a timely fashion to ensure 7-10 day turnaround.

Communicates with Senior Claims Analyst, Account Management and Customer Service Manager, and Claims Manager to ensure proper handling of issues.

Calls all members back within 24 hours of escalation.

Claims processing knowledge.

Answers phone calls utilizing efficient interpersonal and communication skills, as well as excellent telephone and customer service skills and etiquette, as needed and during high call volume.

Exhibits an attention to detail.

Exhibits a strong work ethic.

Be organized and able to manage time and resources efficiently and effectively.

Ability to maintain 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.

Maintains and enters notes with details and accuracy on call log tracking application.

Maintains production goals regarding the number of cases received and closed.

Enters case information into the Resolution Database to keep team informed of status of issues.

Completes other projects as assigned.

Handles competently all cases including those relating, but not limited to potential

a. Stop loss issues

b. TPL issues

c. High dollar claims

d. Vendor / Network Disputes

Complies with company policies and procedures as outlined in the Employee Handbook.

Complies with department policies and procedures.

Assists in training other employees at the manager’s request.

Performs special projects at the request of management.

Regular, predictable attendance is required.

Ability to get along and work effectively with others

Qualifications :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and / or Experience : High school diploma or general education degree (GED); or one to three months related experience and / or training; or equivalent combination of education and experience.

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.

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