Lucent Health

Analyst

• Evaluate large medical and pharmacy claims for stop loss reimbursement eligibility
• Assist in preparation and submission of stop loss claims to carriers, ensuring compliance with contract terms
• Monitor reimbursements and maintain status updates on pending claims
• Collaborate with internal departments (Claims, Care Management, Finance) to gather documentation
• Liaise with stop loss carriers to resolve claim issues and provide necessary support
• Maintain detailed records in accordance with regulatory and HIPAA standards
• Identify process inefficiencies and recommend improvements to optimize claims cycle time

Stop Loss Analyst

Account Manager

• Assist Account Executive Team in managing an assigned book of business and building, expanding, and solidifying relationships with existing clients and Brokers
• Identify benefit plan issues and serve as liaison between the Operations Team and the Client to ensure the benefit program is administered as intended
• Provide clients with appropriate resources and act as main day-to-day contact for escalated claims, billing and enrollment questions
• Focus on retaining existing business with excellent customer service
• Assist in identifying opportunities to improve client and member experience
• Provide administrative and customer service support to main Employer contacts/Plan decision makers
• Support Senior Account Executive staff with New Business and Renewal implementation tasks
• Assist in reporting requests: weekly, monthly and quarterly specialty plan analysis reporting
• Assist with end of contract Stop Loss review
• Assist with special projects as necessary (e.g., Sales RFP requests)