[Hiring] Claims Specialist @Luminare Health

Role Description

Claims Specialist

• 4 years medical claims processing experience.
• Must possess and apply a comprehensive knowledge of specialized medical claims processing, an understanding of code review edits as well as fraud and abuse patterns.
• Ability to provide excellent communication in verbal and written form.
• Excellent interpersonal skills.
• Performance and audit scores of 99% payment, 97% financial and 97% accuracy (or better).
• Familiarity with various PPO reimbursement methodologies.
• Possess a basic knowledge/understanding of stop loss coverage.
• Computer proficiency in Microsoft Office programs.
• Exceptional organization skills.
• Extremely detail oriented.
• Ability to work effectively with team members, employees, providers, and clients.
• Ability to work in a fast-paced, customer service driven environment.
• Supervisor work ethic.

Qualifications

• Strong disability and/or life claim knowledge - understanding of all aspects of claims examining; solid investigation, analytical and organizational skills, and attention to detail or the equivalent combination of relevant experience.
• Minimum five years insurance claim experience with an understanding of medical terminology.
• Must have strong math and decision-making skills, the ability to keep accurate, detailed records and the ability to thoroughly document claim information.
• Possess creative problem solving and conflict resolution skills.
• Ability to organize workflow and accept additional tasks and projects.
• Developing an understanding of the operations of other company departments and their relationship to team responsibilities is essential.
• Strong time management skills to prioritize workload, manage numerous tasks, and provide support to other team members.
• Must be a self-starter, as defined by their ability to take responsibility for prioritizing, managing and following up on numerous tasks.
• Capable of making decisions in the absence of specific directions, independently or with minimal supervision.
• Must have excellent verbal and written communication skills with a passion for helping others.
• Capable of making informed decisions, handle pressure well, interact effectively with other departments and meet prescribed deadlines.
• Ability to foster a positive team environment.
• Possess adaptability to new systems, policies and environments; responsive to change and improvement methodologies.
• Effective in the use of personal computers and related software. Proficiency in working with Word, Excel and Outlook, Access preferred.

Preferred Job Qualifications

• 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.

Pay Transparency Statement

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

Min to Max Range: $42,200.00 - $79,300.00

Exact compensation may vary based on skills, experience, and location.