Claims Analyst - LH

Job description

At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary: CLAIMS ANALYST: 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. All claims and inquiries are handled according to the established plan documents, claim processing guidelines, and established total turnaround times. 80% 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...