Sr Claims Analyst

Luminare Health Benefits Inc.; United States; Remote; USD 25,000 - 47,000; Full time

Job summary

Luminare Health seeks a Senior Claims Analyst to support adjudication of life and disability claims and assist the claims team and vendor staff. The role handles medical, dental, and vision claims per plan documents and guidelines, advising teammates on processing procedures.

Responsibilities include securing claim data, analyzing information for determinations, calculating benefits, and delivering timely, customer-focused communication to all stakeholders across departments and levels.

Qualifications

• Must have a High School diploma or GED.
• Minimum 3 years of medical claim processing experience.
• Ability to work in a fast-paced, customer-centric environment.
• Excellent verbal and written communication skills.
• Ability to interact with members, providers, clients and staff at all levels.

Responsibilities

• Secure and analyze claim information to make benefit determinations.
• Calculate benefit payments and communicate claim decisions.
• Provide responsive and caring customer service under supervision.

Skills

Excellent verbal and written comms

Fast-paced environment

Self-directed

Leadership and interpersonal skills

Education

High School diploma or GED

Four-year college degree in medical or business field a plus

Job description

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

Preferred Job Qualifications:

• Health Insurance/Third Party Administrator Experience
• Four-year college degree in medical and/or business field a plus. Understanding of medical terminology

This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.

EEO Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics. We are a drug-free and smoke-free workplace. Employment may be contingent upon successful completion of drug screening in accordance with applicable law.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support our life outside of work. From 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, plus other incentives, we offer a robust total rewards package for associates. 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 depending on skills, experience, and location.

Luminare Health, a wholly owned subsidiary of Health Care Service Corporation (HCSC), is on track to become the nation’s best and largest third-party administrator. We are committed to delivering service excellence and dedicated to making healthcare simpler, better, and more affordable for our clients and their members. Our people are at the heart of everything we do. We foster a collaborative, purpose-driven culture where employees are empowered to make an impact, grow their careers, and help transform the healthcare experience.