Senior Claims Analyst

🔥 0 minutes 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 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 turnaround times • Advise team members on 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 supervision of management

🎯 Requirements

• High School diploma or GED equivalent • 3 years prior medical claim processing experience • Minimum three-years life and/or disability claim administration experience, or the 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 and ability to carry out oral, written or diagrammed instructions • Flexible and open to continued process improvements • Self-directed and able to work 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 and effectively use MS Excel/Word • Strong math and decision-making skills • Self-motivated with high learning agility • Strong time management skills to prioritize workload, manage and follow up on numerous tasks • Capable of making decisions independently or with minimal supervision • Ability to cope with change and shift gears in a dynamic environment • Strong commitment to teamwork and ability to work collaboratively • Effective use of personal computers and related software • Proficiency in Word, Excel and Outlook; Access preferred • Understanding of medical terminology 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