The Senior Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and vision claims while serving as a liaison for internal departments. They also analyze life and disability information to make benefit determinations and provide guidance to team members regarding processing procedures.
The Client Manager is responsible for managing the overall relationship with clients, from implementation through renewal and daily problem resolution. They serve as the primary point of contact for benefits and HR staff while ensuring the delivery of Luminare Health products and services.
The Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, and vision claims according to plan documents. They must handle correspondence and electronic inquiries while maintaining established turnaround times.
This position is responsible for resolving claim and customer service issues by researching problems and recommending process improvements. The role involves communicating with clients and internal teams while monitoring and tracking issue resolution.
The Case Manager serves as a liaison between patients, physicians, and healthcare providers to coordinate care. They are responsible for assessing, planning, implementing, and monitoring patient care options.
The Quality Management Specialist coordinates and implements quality improvement initiatives while ensuring compliance with state, federal, and accreditation standards. This role monitors performance metrics, conducts audits, and collaborates cross-functionally to promote high-quality healthcare management operations.
The Strategic Reporting Consultant defines and governs the end-to-end reporting strategy across all lines of business to ensure data consistency and accuracy. They act as a strategic advisor to leadership, translating complex data into actionable insights while leading cross-functional teams to deliver high-value reporting solutions.
The Sr. Reinsurance Administrator is responsible for the accurate and timely filing of excess risk claims and handling complex stop-loss claim situations. They also assist with reporting initiatives, testing, and training new reinsurance analysts.
The Outbound File Technical Analyst serves as the subject matter expert for outbound file layouts, collaborating with programmers to build, test, and deploy data files for vendors. They are responsible for analyzing vendor needs, writing business requirements, and ensuring the accuracy of production data through rigorous testing and auditing.
Provides telephonic support to clients to help them navigate healthcare, wellness, and incentive programs. Resolves complex benefit and claim issues while coordinating with providers and insurers.
Benefit Advocates manage and coordinate high-volume service requests via phone, email, and chat to assist employees with their healthcare benefits. They educate callers on benefit plans and provide guidance to help them maximize the value of their employer-provided incentive programs.
The Intake Coordinator is responsible for accurately and respectfully triaging inquiries from members, providers, and clients via phone, email, and electronic systems. They handle various tasks including pre-certification requests, benefit verification, and status updates while maintaining high service standards.
The Sr. Reinsurance Administrator is responsible for the accurate and timely filing of excess risk claims and handling complex stop-loss claim situations. They also provide reporting to carriers, train new analysts, and investigate reimbursement denials.
Provide quality service by responding to high-volume telephonic, written, and electronic inquiries regarding benefits, eligibility, and claim status. Accurately document all actions and navigate multiple system applications to resolve member and provider issues.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Focus on achieving client service expectations, meeting service objectives, and fostering staff development.
Supervise and manage a remote team of inbound and outbound customer service representatives to ensure exceptional service delivery. Responsible for meeting client service expectations, achieving health benefits objectives, and overseeing staff development.
Manage and coordinate a high volume of service requests via phone, email, portal, and chat for client employees and their families. Educate callers on navigating and maximizing the value of their healthcare benefits and incentive programs.
Responsible for the accurate filing of excess risk medical claims and coordinating with stop loss carriers for reimbursements. The role involves managing appeals, distributing reports, and notifying stakeholders when claimants reach specific deductible thresholds.
