Senior Claims Analyst

🔥 0 minutes ago

🦌 Connecticut, Oklahoma, +3 more states – Remote

🦌 Connecticut – Remote 🌪️ Oklahoma – Remote 🏰 Missouri – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $54.8k - $73.3k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

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Lumeris

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lumeris is a company focused on providing value-based care solutions within the healthcare industry. With over a decade of leadership in this field, Lumeris partners with health systems to improve patient outcomes and drive financial success through tech-enabled solutions. Their platform supports population health management, clinical delivery transformation, and payer contracting, offering comprehensive solutions for acute, post-acute, and high-risk patient management. Lumeris is recognized for creating significant cost savings and achieving excellent patient outcomes, including a 5-star CMS rating for its Medicare Advantage Prescription Drug Plan.

📋 Description

• Research, process, and resolve claims at all levels of complexity • Handle complex situations and prioritize project work according to timeliness requirements • Collaborate across departments to resolve complex claim inquiries and research issues • Perform claim adjustments and handle claim correspondence • Work complicated reports involving adjustments, overrides, copayments, coinsurance, pricing, provider selection, and maximum out-of-pocket issues • Participate in meetings with clients, vendors, and internal departments as a Claims subject matter expert • Make outbound calls to members, providers, hospitals, vendors, or other sources to resolve open issues • Serve as a resolution escalation point for peers • Coach, mentor, and support junior team members • Lead payment integrity initiatives, including vendor interfaces, adjustment of findings, and reporting • Identify and close gaps in claims and system handling • Follow written desk procedures and work with limited supervision

🎯 Requirements

• High school diploma, GED, or equivalent • 3+ years of experience in a related role, or the knowledge, skills, and abilities to succeed in the role • Advanced knowledge of Facets claims processing and adjustment handling • Advanced knowledge of Medicare/MAO claims processing • Advanced knowledge of departmental workflows, processes, and procedures • Highly skilled at researching and understanding complex information, including government regulations and contracts • Ability to solve complex or ambiguous problems • Excellent attention to detail • Ability to work in a fast-paced environment with multiple high priorities • Flexibility and adaptability to frequently changing guidelines and processes • Good working knowledge of Federal, State, and local healthcare regulations • Strong collaboration and effective written and verbal communication skills • Proficiency with Microsoft Office Suite and other business applications • Experience working with 10-key and excellent keyboarding skills • Sense of urgency and ability to move effectively between tasks • Basic experience educating peers on department processes and procedures • Must be authorized to work in the United States; visa sponsorship is unavailable • Preferred: Bachelor's degree • Preferred: CMS Audit experience

🏖️ Benefits

• Medical, Vision and Dental Plans • Tax-Advantage Savings Accounts (FSA & HSA) • Life Insurance and Disability Insurance • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) • Employee Assistance Program • 401k with company match • Employee Resource Groups • Employee Discount Program • Learning and Development Opportunities • Performance-based incentive and/or equity may be available depending on the position • Approved COVID-19 vaccination requirement for personnel who interact with at-risk members or prospects