Senior Claims Analyst

🔥 16 hours ago

🇺🇸 United States – Remote

💵 $18 - $33 / hour

⏰ Full Time

🟠 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

• 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 other related claims • Handle related correspondence and electronic inquiries for assigned groups • Process claims and inquiries according to plan documents, claim processing guidelines, and established turnaround times • Advise team members regarding claim processing procedures • Secure and analyze claim information to make life and disability benefit determinations in accordance with 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 supervision of management

🎯 Requirements

• High School diploma or GED equivalent • 3 years prior medical claim processing experience • Ability to work in a fast-paced, customer centric & production driven environment • Excellent verbal and written communication skills • Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff • Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram form • Flexible; open to continued process improvements • Self-directed individual who works well with minimal supervision • Good leadership, organizational and interpersonal skills • Ability to effectively handle with complex situations and reach resolution • Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) • Ability to adapt to various system platforms, and to effectively use MS Excel/Word • Minimum three-years life and/or disability claim administration experience • Solid investigation, analytical and organizational skills along with attention to detail • Strong math and decision-making skills • Must be able to work in a deadline driven, fast-paced environment • Self-motivated with high learning agility • Must be a self-starter with strong time management skills to prioritize workload, manage and follow-up on numerous tasks • Capable of making decisions in the absence of specific directions, independently or with minimal supervision • Ability to effectively cope with change and shift gears accordingly in a dynamic environment • Must display a strong commitment to teamwork and have the ability to work in a collaborative environment • Effective in the use of personal computers and related software • Proficiency in working with Word, Excel and Outlook; Access preferred • Understanding of medical terminology preferred • Health Insurance/Third Party Administrator Experience preferred • Four-year college degree in medical and/or business field a plus

🏖️ 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