Claims Analyst - LH

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Job Summary

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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.

CLAIMS ANALYST

80%

Review, analyze and interpret claim forms and related documents.

Determine benefit coverage based on clinical edits, plan documents/booklets, benefit reference documents, Claim Reference Manuals and claims-related memoranda, and reports.

Appropriately investigate, pend and refer claims based on claim procedures and guidelines.

Accurately handle correspondence, claims, and referrals in the established timeframes and/or performance guarantees.

Support the Claims reinsurance team, in the research and resolution of claims as assigned

15%

Support internal departments in the research and resolution of claims

Communicate via telephone, email, electronic messaging, fax, or written letter with employees/members, providers of service, clients and/or other insurance carriers to ensure proper claim processing

5%

Other duties as needed/assigned

Customer Service – Research and respond to a high volume of customer service phone calls within stated time specifications, following established department guidelines. Ability to work with other team members in management of customer service calls. Resolve issues through effective oral and written communication and by involving appropriate people within, or outside, the department or Company. Effectively and professionally represent the Company in all interactions.

Resource Development/Training – Provide support, training and back-up to the Claims Assistant and other team members, as needed. Assist in establishing procedural manuals and keeping procedure documents current and up to date.

CLAIMS ANALYST

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

CLAIMS ANALYST

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

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

EEO Statement:

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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\.97 - $28\.12

Exact compensation may vary based on skills, experience, and location.