Claims Analyst - LHB

Health Care Service Corporation

2d•$15 - $28•Onsite

About The Position

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. CLAIMS ANALYST The Claims Analyst is responsible for 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. LIFE & DISABILITY - CLAIMS ANALYST The life and disability claims analyst are responsible for securing and analyzing claim information to make accurate benefit determinations on disability claims or other claim types as assigned, in accordance with policy provisions, established claim processing guidelines 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 within established turnaround times. Provide responsive and caring customer service. All tasks completed under general supervision of management.

Requirements

High School diploma or GED equivalent
Ability to work in a fast-paced, customer centric and production driven environment
Effective verbal and written communication skills
Ability to work effectively with team members, employees/members, providers, and clients
Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
Flexible; open to continued process improvement
Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word
An understanding of claims examining; solid investigation, analytical and organizational skills, and attention to detail.
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 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.

Nice To Haves

1 year Health Insurance experience
Self-Funded Insurance/Benefits and/or TPA experience
Knowledge of medical procedure and diagnosis coding
Knowledge of medical terminology
Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools
Four-year college degree in medical and/or business field.
Life and/or Disability claim knowledge.
Proficiency in working with Microsoft Access.

Responsibilities

Accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups.
Handle all claims and inquiries according to established plan documents, claim processing guidelines, and established total turnaround times.
Secure and analyze claim information to make accurate benefit determinations on disability claims or other claim types as assigned, in accordance with policy provisions, established claim processing guidelines and appropriate state and federal laws.
Achieve results by effective use of all appropriate resources.
Calculate benefit payments and communicate claim decisions on new and continuing claims within established turnaround times.
Provide responsive and caring customer service.