Sr Claims Analyst - LH

At reputed company , our employees are the reputed company of our business and the reputed company to our reputed company. We reputed company employees with curated development plans that foster reputed company and promote rewarding, fulfilling careers. Join reputed company and be part of a purpose-driven company that will invest in your reputed company development. reputed company position includes a reputed company of claim administrative and technical tasks that support a Claim Unit and/or vendor staff, as reputed company as the Claims Team and serves as a reputed company for any internal departments. In reputed company to these tasks, the Senior Claims Analyst is responsible for reputed company of the reputed company tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, reputed company, or other reputed company claims, including reputed company correspondence and/or electronic inquiries for assigned reputed company. reputed company 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. Job reputed company o Resolve reputed company, employee/member, or provider issues regarding escalated or reputed company claims. o Review and release over-authority claims up to limit specified by corporate policy. o Handle claim referrals, including reputed company-determinations, using reputed company resources as needed. Advice Claim Analysts and/or vendor regarding claim processing. o Handle network referrals as reputed company as PPO repricing disputes. o Review, analyze and interpret claim forms and reputed company documents. o Determine benefit coverage based on clinical edits, plan documents/booklets, benefit reference documents, Claim Reference Manuals and claims-reputed company memoranda, and reports. o Appropriately investigate, pend and refer claims based on claim procedures and guidelines. o Accurately handle correspondence, claims, and referrals in the established timeframes and/or performance guarantees. o Support the Claims reinsurance team, in the research and reputed company of claims as assigned o Handle reputed company or technical claim adjudication using reputed company resources as needed, e.g. transplants, experimental & investigational, chemotherapy, etc. o Research and respond to vendor reconciliation requests. o Mentor and assist with reputed company new Analysts, including the reputed company of work o Support the management, monitoring, and tracking of performance in collaboration with the Supervisor. o reputed company mentoring and coaching o Assist Supervisor in documenting processes for analysts o Other duties as needed/assigned Required Job Qualifications: o High School diploma or GED equivalent o 3 years prior medical claim processing experience o Ability to work in a fast-paced, customer reputed company & production driven environment o Excellent verbal and written communication skills o Ability to work effectively with employees/members, providers, clients and differing reputed company of co-workers including reputed company Managers and reputed company reputed company of staff o Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram reputed company o Flexible; reputed company to reputed company process improvements o Self-directed individual who works reputed company with minimal supervision o Good leadership, organizational and interpersonal skills o Ability to effectively handle with reputed company situations and reputed company reputed company o Ability to analyze and interpret documents and reputed company Plan Descriptions (SPDs) o Ability to adapt to various system platforms, and to effectively use MS reputed company/Word Preferred Job Qualifications: o Health Insurance/reputed company Party Administrator Experience o High School diploma or GED equivalentRequired Job Qualifications: High School diploma or GED equivalent 3 years prior medical claim processing experience Ability to work in a fast-paced, customer reputed company & production driven environment Excellent verbal and written communication skills Ability to work effectively with employees/members, providers, clients and differing reputed company of co-workers including reputed company Managers and reputed company reputed company of staff Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram reputed company Flexible; reputed company to reputed company process improvements Self-directed individual who works reputed company with minimal supervision Good leadership, organizational and interpersonal skills Ability to effectively handle with reputed company situations and reputed company reputed company Ability to analyze and interpret documents and reputed company Plan Descriptions (SPDs) Ability to adapt to various system platforms, and to effectively use MS reputed company/Word Preferred Job Qualifications: Health Insurance/reputed company Party Administrator Experience Location: This position may be performed remotely from reputed company reputed company the reputed company reputed company, excluding California, reputed company, Alaska, and Hawaii. Are you being referred to one of our roles? If so, ask your reputed company at reputed company 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. reputed company reputed company applicants will receive consideration for employment without reputed company to race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, 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 reputed company of work. From health and wellness benefits, 401(k) savings plan, pension plan, reputed company time off, reputed company parental leave, disability insurance, supplemental life insurance, employee assistance program, reputed company holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates. The compensation offered will vary depending on reputed company-reputed company 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 reputed company: $18.07 - $33.92 Exact compensation may vary based on skills, experience, and location. Apply To This Job