Luminare Health ยท 10 hours ago
Manager Claims - LHB (Tribal Health)
United States
Full-time
Remote
Mid, Senior Level
$48K/yr - $91K/yr
3+ years expLuminare Health is a purpose-driven company that values employee development and success. The Claim Manager is responsible for supervising a team of Claim Analysts and managing client relationships, ensuring quality and service expectations are met while providing support for complex claims and customer service inquiries.
Health CareInsuranceTelehealth
No H1B
Responsibilities
Responsible for the day-to-day supervision and management of a team, or multiple teams, of Luminare Health Claim Analysts and/or outsourced vendor staff enabling the department to meet its client and corporate commitments
Successful achievement of team quality, production and service expectations
Staff development
Successful implementation of new clients into the Unit
Retention of existing clients
Responsible for answering complex or difficult claim or customer service questions
Advising team members regarding claim processing or customer service procedures
Providing support to ensure all department goals are met
Expected to have greater visibility and accountability than a Claim Supervisor
May involve responsibility for multiple Claim Units, each with its own Supervisor, a Claim Unit with more complex or visible clients, and/or management of an outsourced vendor relationship
Qualification
Required
High School Diploma or GED equivalent
3-5 years claim processing experience
Previous supervisory or management experience
Self-directed individual who works well with minimal supervision
Excellent verbal and written communication skills
Strong leadership, organizational and interpersonal skills
Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
Ability to effectively deal with problems in varying situations and reach resolution
Ability to read, analyze and interpret documents and Summary Plan Descriptions (SPDs)
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
Preferred
Minimum 5 years of medical claims experience specifically in the Tribal healthcare/benefits arena
In depth understanding of Tribal client rules and products such as Payor of last resort, MLR, Sponsorship, Chef reimbursement, and COB rules
Self-Funded Insurance/Benefits and/or TPA experience
Bachelor's degree
Benefits
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
Other incentives
Company
Luminare Health
Luminare Health offers healthcare management services, focusing on cost control and risk management for self-funded employers.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ashley Pond
Executive Director, National Partnerships
Company data provided by crunchbase