Claims Analyst

Luminare Health

Claims Analyst responsible for processing various claims including medical, dental, and vision at Luminare Health. Requires effective communication, analytical skills, and a fast-paced work environment.

Posted 5/20/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $15 - $28 per hourWebsite

About the role

Key responsibilities & impact

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.
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.
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.
Provide responsive and caring customer service.
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.

Requirements

What you’ll need

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
1 year Health Insurance experience (preferred)
Self-Funded Insurance/Benefits and/or TPA experience (preferred)
Knowledge of medical procedure and diagnosis coding (preferred)
Knowledge of medical terminology (preferred)
Familiarity with Summary Plan Documents (SPDs)/Insurance Booklets or other benefit descriptive tools (preferred)

Benefits

Comp & perks

Health insurance
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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims adjudicationclaims processingmedical codingdiagnosis codingbenefit coverage determinationclaims investigationclaims resolutioncustomer service

Soft Skills

effective communicationteam collaborationproblem-solvingflexibilityattention to detail

Certifications

High School diplomaGED equivalent