Sr Claims Analyst - LHB

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.

About the Role

Luminare Health is a purpose-driven team focused on making healthcare simpler, better, and more affordable. Our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success.

Required Job Qualifications

• A high school diploma or GED equivalent
• Three years prior medical claim processing experience
• Excellent verbal and written communication skills
• Ability to work in a fast-paced, customer-centric, and production-driven environment
• 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
• Excellent verbal and written communication skills with a passion for helping others
• 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
• Strong commitment to teamwork and 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
• Four-year college degree in medical and/or business field a plus
• Understanding of medical terminology