Luminare Health

1,001 – 5,000 कर्मचारी

Luminare Health स्व-वित्तपोषित स्वास्थ्य योजनाओं के प्रशासन और स्वास्थ्य सेवा लागत प्रबंधन की सेवाएँ प्रदान करती है। उद्योग में 50 से अधिक वर्षों के अनुभव के साथ, कंपनी अस्पतालों, स्वास्थ्य प्रणालियों और नियोक्ता-प्रत्यक्ष कार्यक्रमों के लिए दावों के प्रशासन, उच्च-लागत दावों के विश्लेषण, लागत नियंत्रण और डिजिटल रिपोर्टिंग पर काम करती है। इसका दृष्टिकोण सदस्य-केंद्रित स्वास्थ्य सेवा सहायता को डेटा-आधारित प्रशासन के साथ जोड़ता है, ताकि ग्राहक खर्चों का प्रबंधन कर सकें और रणनीतिक विकास को आगे बढ़ा सकें।

कंपनी की नौकरियाँ

Remote Claims Specialist

Process medical, life, and disability claims for Luminare Health in a remote role. Investigate claims, apply reimbursement methods, and document decisions accurately.

3 सप्ताह पहले

संयुक्त राज्य

$42,200 – $79,300 / वर्ष

रिमोट पूर्णकालिक मध्य स्तर वरिष्ठ आवश्यक भाषा: अंग्रेज़ी दावा विशेषज्ञ

विवरण

Review and process medical, life, and disability claims.
Use specialized medical claims expertise and apply code review edits.
Spot potential fraud and abuse patterns.
Apply PPO reimbursement methods and use knowledge of stop-loss coverage.
Investigate claims and make informed analytical and mathematical decisions.
Keep detailed records and document claim information thoroughly.
Plan workflow, prioritize assignments, manage multiple tasks, and meet deadlines.
Take on additional projects and tasks while supporting teammates.
Work with colleagues, employees, providers, clients, and other departments.
Adjust to new systems, policies, work environments, and improvement methods.
Contribute to a constructive team environment.
Provide service in a fast-paced, customer-focused setting.

आवश्यकताएँ

At least four years of experience processing medical claims.
Broad knowledge of specialized medical claims processing.
Understanding of code review edits and fraud and abuse patterns.
Strong written and spoken communication skills.
Strong interpersonal skills.
Payment performance and audit scores of at least 99%, financial scores of at least 97%, and accuracy scores of at least 97%.
Familiarity with different PPO reimbursement methods.
Basic knowledge of stop-loss coverage.
Proficiency with Microsoft Office applications.
Excellent organizational ability.
Exceptional attention to detail.
Ability to work effectively with colleagues, employees, providers, and clients.
Ability to work in a fast-paced, customer-focused setting.
Strong disability and/or life claims knowledge, including all aspects of claims examination.
Sound investigation, analytical, and organizational skills.
Attention to detail or an equivalent combination of relevant experience.
At least five years of insurance claims experience and knowledge of medical terminology.
Strong math and decision-making abilities.
Ability to maintain detailed records and document claim information thoroughly.
Creative problem-solving and conflict-resolution skills.
Ability to organize workflow and take on additional tasks and projects.
Strong time-management skills.
Ability to prioritize work, manage multiple tasks, and support teammates.
Ability to make decisions independently or with minimal supervision.
Strong written and spoken communication skills.
Ability to work under pressure, coordinate with other departments, and meet deadlines.
Ability to adapt to new systems, policies, and work environments.
Effective use of computers and related software.
Proficiency with Word, Excel, and Outlook; Access is preferred.

लाभ

Health and wellness coverage.
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 its terms and conditions.
Remote work from within the continental United States, excluding California, New York, Alaska, and Hawaii.
Drug-free and smoke-free workplace.

संबंधित नौकरियाँ

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