Sr Claims Analyst - LHB

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

Job summary

Luminare Health is seeking a Senior Claims Analyst to handle life and disability claim adjudication and related inquiries for assigned groups. You will support a Claims Unit and liaise with internal departments and vendor staff to ensure accurate processing.

Responsibilities include analyzing claim information, determining benefit payments, communicating decisions, and advising teammates on processing procedures.

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, providers, clients and staff at all levels.
• Demonstrated critical thinking and problem solving.
• Flexible and open to process improvements.
• Self-directed with good time management and leadership potential.
• Ability to interpret SPDs and healthcare documents.

Responsibilities

• Adjudicate medical, dental, vision, or related claims according to plan documents.
• Support a Claim Unit and liaison with internal departments and vendors.
• Advise team on claim processing procedures and guidelines.
• Calculate benefits and communicate decisions to stakeholders.
• Provide responsive, caring customer service and meet turnaround times.
• Analyze claim information to determine accurate outcomes.

Skills

Claim processing

Communication

Analytical thinking

Time management

Teamwork

Healthcare terminology

Education

High School diploma or GED

Four-year college degree a plus

Tools

MS Excel

MS Word

Outlook

Access

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)
• 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

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

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.

Pay Transparency Statement:

At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their 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 forassociates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plansubject 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.