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.
Location: This position may be performed remotely from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii.
This position supports Tribal ESR operations and serves a highly visible Tribal customer group. Candidate must demonstrate the ability to provide a consistently high level of service, professionalism, and responsiveness to meet the service expectations and unique needs of Tribal business partners.
This position is responsible for working with external customers to resolve claim and customer service issues initiated by clients or Client Management. Responsibilities include research and resolution of issues; recommendations for improvement of processes and procedures to eliminate recurrence of issues or to prevent future issues; communication with clients, Operations and Client Management; and tracking/monitoring of issues. This position may not service all clients.
Research and resolve claim issues initiated by clients and/or brokers.
Provide timely written or verbal status updates and explanations to clients, brokers or Client Management regarding issues.
Follow-up regularly on outstanding issues to ensure timely resolution and client satisfaction.
Appropriately notify, refer or escalate issues.
Track issues and document resolution. Provide issue reports to Claims & Customer Management and Client Management on a regular basis. May also provide periodic reports to clients.
Recommend process, procedure or other actions to eliminate reoccurrence of issues or prevent future issues.
Develop and maintain good relationships with select clients, Client Management and Claims & Customer Service personnel.
Assist with benefit fairs or benefit meetings
Complete special client requests or projects, as directed
Other duties as needed/assigned
Required Job Qualifications:
Tribal experience required
High School diploma or GED equivalent
Minimum five or more years claim processing/health insurance industry experience
Ability to work in a fast-paced, customer service driven environment
Excellent verbal and written communication skills
Ability to research various topics, succinctly summarize findings and develop a recommendation
Ability to work effectively with employees/members, providers, clients and differing levels of co-workers including Client Managers and all levels of staff
Solid understanding of ERISA and DOL regulations
Ability to read, analyze and interpret documents and Summary Plan Descriptions (SPDs)
Flexible; open to continued process improvement
Self-directed individual who works well with minimal supervision
Good leadership, organizational and interpersonal skills
Demonstrated critical thinking skills
Ability to effectively deal with problems in varying situations and reach resolution
Ability to learn new/proprietary systems, to adapt to various system platforms, and to effectively use MS Excel/Word
Preferred Job Qualifications:
Bachelor’s degree
Good presentation skills
Experience presenting and explaining benefits to a group or one-on-one
Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!
We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.
Pay Transparency Statement:
At Luminare, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, plus other incentives, we offer a robust total rewards package for associates
The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.
Min to Max Range:
$42,200.00 - $79,300.00
Exact compensation may vary based on skills, experience, and location.
Luminare Health is one of the largest third-party benefits administrators in the nation, delivering comprehensive benefits solutions that help self-funded employers control healthcare costs, design smarter benefit plans, and achieve long-term growth. As a subsidiary of Health Care Services Corporation, we combine decades of industry expertise with innovative tools that simplify administration, improve utilization, and elevate the member experience. We work with employers across all industries, with special experience in the particular needs of hospitals and health systems, as well as tribal organizations. Our focus on delivering service excellence guides our day-to-day operations and our long-term strategic planning to support our mission of making healthcare accessible and affordable. We provide transparency, flexibility, and results for our clients, helping them to exceed their financial goals and their members to live healthier lives.
