
1001 - 5000 employees
đĽ Healthcare
đź Consulting
đŚ 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.
đ August 26
đŞď¸ Kansas â Remote
đľ $18 - $33 / hour
â° Full Time
đ Senior
đ Claims Specialist
đť Ghost score 4%
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1001 - 5000 employees
đĽ Healthcare
đź Consulting
đŚ 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.
⢠Perform claim administrative and technical tasks supporting a Claim Unit, vendor staff and the Claims Team ⢠Serve as a liaison for internal departments ⢠Accurately adjudicate and process medical, dental, vision and related claims ⢠Handle related correspondence and electronic inquiries for assigned groups ⢠Process claims and inquiries according to plan documents, claim processing guidelines and turnaround times ⢠Advise team members regarding claim processing procedures ⢠Secure and analyze claim information to make life and disability benefit determinations ⢠Apply policy provisions and applicable state and federal laws ⢠Calculate benefit payments ⢠Communicate claim decisions on new and continuing claims ⢠Provide responsive and caring customer service ⢠Complete tasks under general management supervision
⢠High School diploma or GED equivalent ⢠3 years prior medical claim processing experience ⢠Minimum three years life and/or disability claim administration experience, or equivalent combination of relevant experience ⢠Ability to work in a fast-paced, customer-centric and production-driven environment ⢠Excellent verbal and written communication skills ⢠Ability to work effectively with employees/members, providers, clients and differing levels of co-workers ⢠Demonstrated critical thinking ⢠Flexible and open to continued process improvements ⢠Self-directed individual who works well with minimal supervision ⢠Good leadership, organizational and interpersonal skills ⢠Ability to handle complex situations and reach resolution ⢠Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) ⢠Ability to adapt to various system platforms ⢠Effective use of MS Excel and Word ⢠Strong math and decision-making skills ⢠Strong time management skills ⢠Ability to work independently or with minimal supervision ⢠Ability to work in a collaborative environment ⢠Effective use of personal computers and related software ⢠Proficiency in Word, Excel and Outlook ⢠Preferred: Health Insurance/Third Party Administrator Experience ⢠Preferred: Understanding of medical terminology ⢠Preferred: Four-year college degree in medical and/or business field
⢠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
Apply Nowđ August 26
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