[Hiring] Senior Claims Analyst @Luminare Health

Role Description

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.

The Senior Claims Analyst is responsible for:

• Accurate adjudication and processing of medical, dental, vision, or other related claims.
• Handling related correspondence and/or electronic inquiries for assigned groups.
• Ensuring all claims and inquiries are handled according to established plan documents, claim processing guidelines, and established total turnaround times.
• Advising team members regarding claim processing procedures.

Specific responsibilities for Life & Disability - Sr Claims Analyst include:

• Secure and analyze claim information to make life and disability benefit determinations in accordance with policy provisions and appropriate state and federal laws.
• Calculate benefit payments and communicate claim decisions on new and continuing claims.
• Provide responsive and caring customer service.

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 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.

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 Job Qualifications

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

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: $18.07 - $33.92. Exact compensation may vary based on skills, experience, and location.