Offer summary

Qualifications:

High School diploma or GED equivalent., Effective verbal and written communication skills., Ability to learn new systems and adapt to various platforms., Experience or knowledge in health insurance, medical terminology, or claims processing is preferred..

Key responsibilities:

Accurately adjudicate and process medical, dental, and vision claims.

Handle related correspondence and electronic inquiries for assigned groups.

Follow established claim processing guidelines and turnaround times.

Collaborate effectively with team members, providers, and clients.

Job description

At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

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.

Required Job Qualifications:

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

Preferred Job Qualifications:

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

LIFE & DISABILITY - CLAIMS ANAYST

Required Job Qualifications:

An understanding of claims examining; solid investigation, analytical and organizational skills, and attention to detail.
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 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.
High School diploma or GED equivalent

Preferred Job Qualifications:

Four-year college degree in medical and/or business field.
Life and/or Disability claim knowledge.
Knowledge of medical terminology.
Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools.
Proficiency in working with Microsoft Access.

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 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:

$14.68 - $27.57

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