Claims Analyst

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Luminare Health

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Healthcare Insurance

Luminare Health is a leading provider of self-funded health plan administration services with over 50 years of industry experience. The company specializes in offering flexible and innovative solutions for hospitals, health systems, and direct-to-employer initiatives, focusing on administration, cost management, and digital reporting tools. Luminare Health is dedicated to being a reliable partner in managing healthcare costs and supporting strategic growth for its clients. The company emphasizes a member-centered approach to healthcare while delivering significant savings through expert claim analysis and management of high-cost claims.

1001 - 5000 employees

⚕️ Healthcare Insurance

📋 Description

• Responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims • Handle related correspondence and/or electronic inquiries for assigned groups • All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times • Responsible for securing and analyzing claim information to make accurate benefit determinations on disability claims or other claim types as assigned • Calculate benefit payments and communicate claim decisions on new and continuing claims within established turnaround times • Provide responsive and caring customer service • Complete all tasks under general supervision of management

🎯 Requirements

• High School diploma or GED equivalent • Ability to work in a fast-paced, customer centric and production driven environment • Effective verbal and written communication skills • Ability to work effectively with team members, employees/members, providers, and clients • Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form • Flexible; open to continued process improvement • Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word • 1 year Health Insurance experience (preferred) • Self-Funded Insurance/Benefits and/or TPA experience (preferred) • Knowledge of medical procedure and diagnosis coding (preferred) • Knowledge of medical terminology (preferred) • Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools (preferred) • Understanding of claims examining; solid investigation, analytical and organizational skills, and attention to detail (required) • Strong math and decision-making skills (required) • Ability to work in a deadline driven, fast-paced environment (required) • Self-motivated with high learning agility (required) • Excellent verbal and written communication skills with a passion for helping others (required) • Strong time management skills to prioritize workload, manage and follow-up on numerous tasks (required) • Capable of making decisions in the absence of specific directions with minimal supervision (required) • Effective in the use of personal computers and related software (required) • Proficiency in working with Word, Excel and Outlook (required) • Four-year college degree in medical and/or business field (preferred) • Life and/or Disability claim knowledge (preferred) • Knowledge of medical terminology (preferred) • Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools (preferred) • Proficiency in working with Microsoft Access (preferred)

🏖️ Benefits

• Health and wellness benefits • 401(k) savings plan • Pension plan • Paid time off • Paid parental leave • Disability insurance • Supplemental life insurance • Employee assistance program • Paid holidays • Tuition reimbursement • Other incentives