Sr Claims Analyst - LHB

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.

Were committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable.

Job Summary This position includes a variety of claim administrative and technical tasks that support a Claim Unit and/or vendor staff, as well as the Claims Team and serves as a liaison for any internal departments.

In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups. All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times. Also advise team members regarding claim processing procedures.

Life & Disability - Sr Claims Analyst
Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws; achieving results by effective use of all appropriate resources. Calculate benefit payments and communicate claim decisions on new and continuing claims. Provide responsive and caring customer service. All tasks completed under general supervision of management.

Required Job Qualifications:

• 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

Preferred Job Qualifications:

• Health Insurance/Third Party Administrator Experience

Life & Disability - Sr Claims Analyst

Minimum Requirements:

• Minimum three-years life and/or disability claim administration experience: solid investigation, analytical and organizational skills along with attention to detail; or the equivalent combination of relevant experience.
• Must have 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 have excellent verbal and written communication skills with a passion for helping others.
• 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.

Preferred:

• Four-year college degree in medical and/or business field a plus.
• Understanding of medical terminology

Disclaimer: This job posting and Location has been aggregated from external source. Role details, content, and availability are subject to change. Applicants are advised to confirm the latest information directly on the company website before applying.