Senior Claims Analyst

🔥 2 hours ago

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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, Claims Team, and internal departments • Accurately adjudicate and process medical, dental, vision, and related claims • Handle related correspondence and electronic inquiries for assigned groups • Process claims according to plan documents, claim processing guidelines, and turnaround times • Advise team members on claim processing procedures • Secure and analyze life and disability claim information • Make life and disability benefit determinations under policy provisions and applicable state and federal laws • Calculate benefit payments • Communicate decisions on new and continuing claims • Provide responsive and caring customer service • Complete tasks under general management supervision

🎯 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, Client Managers, and staff at differing levels • Demonstrated critical thinking and ability to carry out oral, written, or diagrammed instructions • Flexibility and openness to continued process improvements • Self-directed work style with minimal supervision • 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 • Minimum three years of life and/or disability claim administration experience, or equivalent combination of relevant experience • Solid investigation, analytical, and organizational skills with attention to detail • Strong math and decision-making skills • Ability to work in a deadline-driven, fast-paced environment • Self-motivated with high learning agility • Strong time management skills to prioritize workload, manage, and follow up on numerous tasks • Ability to make 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 • Health Insurance/Third Party Administrator experience preferred • Four-year college degree in a medical and/or business field preferred/a plus

🏖️ Benefits

• Thoughtful development opportunities • 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