Claims Analyst
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Job Description
Claims Analyst adjudicating medical, dental, vision, life, and disability claims for Luminare Health. Processing inquiries accurately under plan guidelines and turnaround requirements.
Responsibilities:
- Accurately adjudicate and process medical, dental, vision, life, disability, or other related claims for assigned groups
- Handle related correspondence and electronic inquiries
- Process claims according to established plan documents and claim processing guidelines
- Meet established total turnaround times
- Examine claims and conduct investigations
- Make analytical and claims-related decisions with minimal supervision
- Prioritize workload, manage and follow up on numerous tasks
- Collaborate with team members, employees/members, providers, and clients
- Adapt to process improvements, system platforms, and changing priorities
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 oral, written, or diagram-form instructions
- Flexible and open to continued process improvement
- Ability to learn new/proprietary systems, adapt to various system platforms, and 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
- Ability 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
- 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
- Strong commitment to teamwork and ability to work collaboratively
- Effective use of personal computers and related software
- Proficiency in Word, Excel, and Outlook
- 1 year of health insurance experience (preferred)
- Self-Funded Insurance/Benefits and/or TPA experience (preferred)
- Knowledge of medical procedure and diagnosis coding (preferred)
- Knowledge of medical terminology (preferred)
- Familiarity with Summary Plan Documents (SPDs), insurance booklets, or other benefit descriptive tools (preferred)
- Four-year college degree in medical and/or business field (preferred)
- Life and/or disability claim knowledge (preferred)
- Proficiency in Microsoft Access (preferred)
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
- Annual incentive bonus plan subject to the terms and conditions of the plan
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