Claims Specialist

🔥 1 hour ago

🇺🇸 United States – Remote

💵 $42.2k - $79.3k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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Luminare Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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.

📋 Description

• Process and examine medical, life, and disability claims • Apply specialized medical claims processing knowledge and code review edits • Identify fraud and abuse patterns • Apply PPO reimbursement methodologies and stop loss coverage understanding • Investigate claims and make analytical, mathematical, and informed decisions • Maintain accurate, detailed records and thoroughly document claim information • Organize workflow, prioritize workloads, manage numerous tasks, and meet deadlines • Handle additional tasks and projects and support other team members • Collaborate with team members, employees, providers, clients, and other departments • Adapt to new systems, policies, environments, and improvement methodologies • Foster a positive team environment • Work in a fast-paced, customer service-driven environment

🎯 Requirements

• 4 years medical claims processing experience • Comprehensive knowledge of specialized medical claims processing • Understanding of code review edits and fraud and abuse patterns • Excellent verbal and written communication skills • Excellent interpersonal skills • Performance and audit scores of 99% payment, 97% financial, and 97% accuracy or better • Familiarity with various PPO reimbursement methodologies • Basic knowledge and understanding of stop loss coverage • Proficiency in Microsoft Office programs • Exceptional organization skills • Extremely detail oriented • Ability to work effectively with team members, employees, providers, and clients • Ability to work in a fast-paced, customer service driven environment • Strong disability and/or life claim knowledge and understanding of all aspects of claims examining • Solid investigation, analytical, and organizational skills • Attention to detail or equivalent combination of relevant experience • Minimum five years insurance claim experience with an understanding of medical terminology • Strong math and decision-making skills • Ability to keep accurate, detailed records and thoroughly document claim information • Creative problem solving and conflict resolution skills • Ability to organize workflow and accept additional tasks and projects • Strong time management skills • Ability to prioritize workload, manage numerous tasks, and support other team members • Ability to make decisions independently or with minimal supervision • Excellent verbal and written communication skills • Ability to handle pressure, interact effectively with other departments, and meet prescribed deadlines • Ability to adapt to new systems, policies, and environments • Effective use of personal computers and related software • Proficiency with Word, Excel, and Outlook; 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 • Annual incentive bonus plan subject to the terms and conditions of the plan • Remote work from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii • Drug-free and smoke-free workplace