Senior Claims Analyst

Luminare Health

Claims Analyst resolving escalated claims and supporting team collaboration at Luminare Health. Responsible for adjudicating and processing medical claims while mentoring new analysts.

Posted 6/16/2026full-timeRemote • Alaska, California, Hawaii, New York • 🇺🇸 United StatesSenior💰 $18 - $34 per hourWebsite

About the role

Key responsibilities & impact

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

Requirements

What you’ll need

High School diploma or GED equivalent
3 years prior medical claim processing experience
Ability to work in a fast-paced, customer centric & production driven environment
Excellent verbal and written communication skills
Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
Demonstrated critical thinking, to carry out instructions furnished in oral, written or diagram form
Flexible; open to continued process improvements
Self-directed individual who works well with minimal supervision
Good leadership, organizational and interpersonal skills
Ability to effectively handle complex situations and reach resolution
Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs)
Ability to adapt to various system platforms, and to effectively use MS Excel/Word

Benefits

Comp & perks

Health and wellness benefits
401(k) savings plan
Pension plan
Paid time off
Paid parental leave
Disability insurance
Supplemental life insurance
Employee assistance program
Paid holidays
Tuition reimbursement
Annual incentive bonus plan

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

medical claim processingclaim adjudicationbenefit coverage determinationdocument analysiscritical thinkingperformance trackingmentoringonboardingcorrespondence handlingclaims research

Soft Skills

communication skillsleadership skillsorganizational skillsinterpersonal skillsflexibilityself-directionproblem-solvingcustomer centricityadaptabilityteam collaboration

Certifications

High School diplomaGED equivalent