Luminare Health

Architect

• Identify, prioritize, and architect enterprise-level optimization opportunities across the organization
• Focus on value realization, operational efficiency, and strategic alignment by connecting business strategy to measurable outcomes
• Partner with executive leadership, operations, finance, IT, and performance reporting teams to define optimization roadmaps, quantify benefits, and ensure initiatives deliver sustainable business value
• Develop business cases, value models, and ROI estimates for optimization initiatives
• Define benefit tracking frameworks and monitor realization of benefits
• Provide executive-level insights and recommendations to guide investment decisions
• Act as trusted advisor to senior leaders on operational performance and optimization strategy

Business Optimization Architect

• Responsible for designing, standardizing, and governing end-to-end business processes across the organization.
• Ensures processes are efficient, compliant, scalable, and aligned to enterprise optimization goals.
• Translates optimization strategy into clear, executable, and measurable process designs.
• Establishes standards that support consistent execution across teams and platforms.
• Designs and documents end-to-end processes across claims, enrollment, customer service, utilization management, operations, and finance.
• Develops current-state and target-state process models using standard methodologies (e.g., BPMN).
• Defines process boundaries, handoffs, roles, controls, and decision points.
• Establishes enterprise process standards, modeling conventions, and documentation requirements.
• Maintains a centralized process repository and architecture artifacts.
• Ensures processes align with regulatory, contractual, and audit requirements.
• Partners with Business Optimization Architects to translate optimization initiatives into process designs.
• Supports operational teams during implementation by clarifying process intent and design.
• Provides guidance on process adoption, change impacts, and risk mitigation.
• Identifies process inefficiencies, bottlenecks, and control gaps.
• Supports process measurement by defining operational metrics and controls.
• Incorporates feedback and performance results into ongoing process refinements.
• Works closely with IT, data, compliance, and operations teams to ensure process designs are feasible and enforceable.
• Supports technology enablement efforts by defining business process requirements.

Process Architect

Customer Support

• Responsible for providing quality service by accurately and respectfully responding to telephonic, written and electronic inquiries from employees/members, providers and clients
• Seamlessly navigate multiple system applications/screens, various resources and tools to accurately respond to inquiries while on the phone
• Thoroughly and accurately document all inquiries and actions taken using applicable software applications while following Luminare Health guidelines
• Complete a 4–6 week paid training program

Customer Service Representative

Advocate

• Managing and coordinating a high volume of service requests (phone, emails, portal, chat) from employees (and their immediate family) of our clients
• Educating and assisting callers with understanding, navigating through and obtaining the maximum value of their healthcare and wellness benefits, and employee incentive programs provided by their employers
• Assisting employees to understand their benefit plan offering, and providing direction in working through a variety of benefit issues

Benefit Advocate

Client Partner

• Join a purpose-driven team focused on making healthcare simpler, better, and more affordable
• Handle client management tasks and support client-facing responsibilities
• Collaborate with internal teams to enhance service excellence

Associate Client Manager

Data Analyst

• Responsible for designing, creating and delivering critical plan performance trend analytics, reports, and insights to clients
• Essential to providing a consultative experience to our employer clients that delivers on our promise of bending the medical cost trend
• Develop insights for clients that assist them in problem solving, solution development, decision making and strategic planning around their benefits program
• Collaborate with Client Management on recommendations and next steps based on trend data, client objectives and Luminare Health offering
• Provide analytics support for client, prospect and internal special projects—developing and understanding the relevant data, displaying it clearly and presenting the findings
• Key resource in the evolution and support of upgrading overall data analytics and reporting capabilities
• Work with Data Analytics owner and other relevant support partners to identify and implement needed tools, processes and capabilities
• Partner with Client Management, Data Analytics and Reporting, Healthcare Management, Sales Executives, Product Management, Marketing, Reporting and Business Analysts, IT and other disciplines as needed

Senior Data Analyst II

Administration

• Responsible for accurate and timely filing of excess risk medical claims
• Work collaboratively with excess risk companies to answer questions and resolve problems
• Handle initial appeals for reinsurance
• Coordinate all reporting that is supplied by the excess risk companies
• Identify and prepare stop loss claims submissions to obtain client reimbursement
• Communicate with Client Management, Claims, Finance and other impacted departments
• Identify and notify stop loss carriers and clients of claimants that have reached 50% of the specific deductible amount
• Review and process all returned checks resulting from stop loss reimbursements
• Investigate carrier reimbursement denials and prepare/submit rebuttal or notification of explanation to the client
• Prepare and distribute to Medical Claims Analysts and department Managers notifications of potential specific claimants requiring all claims to be processed by month-end

Reinsurance Administrator

General

• Analyze, document, organize, and publish policies, procedures, and guidelines for internal Operations Divisions
• Work with internal and external customers to gain acceptance and consensus
• Support efforts to improve content taxonomies and content organization
• Stage and publish new and revised records on approval applications
• Secure cooperation of appropriate levels of authority
• Consult with local content owners to ensure standards, templates, and publishing protocol are followed
• Support content organization and standardization efforts that lead to improved search efficiency and improved usability.

Documentation Specialist

Claims Specialist

• Resolve client, employee/member, or provider issues regarding escalated or complex claims.
• Review and release over-authority claims up to limit specified by corporate policy.
• Handle claim referrals, including pre-determinations, using internal and external resources as needed.
• Advise Claim Analysts and/or vendor regarding claim processing.
• Handle network referrals as well as PPO repricing disputes.
• 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.
• Handle complex or technical claim adjudication using internal and external resources as needed, e.g. transplants, experimental & investigational, chemotherapy, etc.
• Research and respond to vendor reconciliation requests.
• Mentor and assist with onboarding new Analysts, including the oversight of work.
• Support the management, monitoring, and tracking of performance in collaboration with the Supervisor.
• Provide mentoring and coaching.
• Assist Supervisor in documenting processes for analysts.
• Other duties as needed/assigned

Senior Claims Analyst

Business Operations

• Responsible for the maintenance, revision, and implementation of Policies and Procedures to ensure compliance with applicable regulatory standards and contractual obligations
• Prepare, develop and make recommendations by analyzing reports and operational data to support operational improvements and enforcement of established standards
• Work collaboratively with overall operations management team to develop operational efficiencies, maintain contractual requirements, and overall compliance of core operations is in conformity with various rules and regulations
• Conduct continual research of new and revised accreditation and regulatory standards applicable to CMS in collaboration with external PSERS vendors
• Maintain a database of regulatory requirements applicable to PSERS processes
• Responsible for the ongoing maintenance and revision of PSERS Division and Utilization Management Policy
• Acts as the Department Liaison for maintenance of required Regulatory Filings/Reports and CMS Inquiries
• Collect, analyze and report on key metrics inclusive of identifying trends, barriers, conducting root cause analysis when applicable and providing objective recommendations
• Recommend process improvements for every day operating procedures
• Assist with the ongoing analysis of the PSERS Program to identify opportunities for process improvement, reengineers processes to improve efficiencies and to ensure compliance
• Provide expertise in regulatory/accreditation issues/inquiries for all PSERS functional areas
• Maintain a positive and educational approach when interacting with both internal and external customers in explaining the Regulatory Compliance Program wants and needs
• Assist with the orientation of personnel and positively contribute to the ongoing networking of expertise with colleagues
• Compile information via data sources and provide back up support for system administration collecting, analyzing, and summarizing information.
• Work collaboratively with management team to work on identified trends and issues for short term and long term resolution, leveraging people, process, technology, and team communications/tools are updated.
• Promptly review Medicare Part A/D changes and determine impact to PSERS operations
• Share the information with operational team and assess impact, implementing changes as needed, to ensure proper tools and educational information is shared with front line team members or impacted individuals
• Review eligibility and customer service audits, as well as Medicare program audits, to assess steps needed to be taken to correct issues, report and respond to CMS.

Business Operations Specialist

Analyst

• Perform project activities including gathering and documenting business needs and requirements
• Establish test plan and develop test scenarios
• Assist in testing processes
• Work closely with team members to document user stories (requirements) and acceptance criteria
• Participate in testing activities for each development phase

Requirements Analyst

Business Intelligence Analyst

• Own the definition, standardization, and governance of operational performance metrics and KPIs
• Ensure consistent application of metric definitions across reports, dashboards, and deliverables
• Maintain reporting calendars, distribution protocols, and version control standards
• Produce and deliver executive-level dashboards, scorecards, and performance summaries
• Lead preparation of SLA reporting and performance guarantee assessments
• Translate operational results into clear narratives, key takeaways, and recommended actions
• Coordinate and deliver performance-related reporting for regulatory, accreditation, and client audits
• Ensure reporting outputs align with contractual and regulatory requirements
• Drive standardization, automation, and scalability of recurring performance reports
• Identify opportunities to streamline reporting workflows and reduce manual effort
• Establish quality review checkpoints for performance reporting deliverables

Senior Performance Reporting Analyst

• Sourcing, transforming, validating, and analyzing data to support performance reporting, operational analytics, and regulatory needs
• Extracting data from core systems, including claims, enrollment, provider, utilization management, call center, and financial systems
• Developing and maintaining SQL queries, views, and data models to support reporting and analytics needs
• Performing data transformations, joins, and aggregations to create analysis-ready datasets
• Supporting data ingestion and integration across multiple source systems
• Performing data validation, reconciliation, and quality checks to ensure accuracy, completeness, and consistency
• Investigating and resolving data anomalies in collaboration with IT, vendors, and business stakeholders
• Documenting data sources, logic, and transformation rules
• Conducting exploratory and ad-hoc analysis to answer operational and business questions
• Supporting root cause analysis and investigative work requested by performance and operations teams
• Identifying data trends, anomalies, and patterns that may impact operational performance
• Delivering validated datasets and analytical outputs to Senior Performance Reporting Analysts and reporting teams
• Supporting the development of dashboards and reports by ensuring that underlying data is accurate and performant
• Assisting with performance metric calculations as defined by reporting governance
• Collaborating with data engineering and IT teams on data warehouse, data mart, and reporting layer enhancements
• Supporting automation of data pipelines and recurring analytical processes
• Participating in data governance, metadata management, and documentation initiatives