Manager Claims - LHB (Tribal Health) at LUMINARE HEALTH BENEFITS INC

Essen, North Rhine-Westphalia, Germany -

Full Time

Start Date

Immediate

Expiry Date

19 Apr, 26

Salary

91000.0

Posted On

19 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claim Processing, Supervisory Skills, Leadership, Communication, Organizational Skills, Interpersonal Skills, Problem Solving, Adaptability, MS Excel, MS Word, Customer Service, Team Development, Quality Assurance, Client Management, Process Improvement, Document Analysis

Industry

Insurance

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 The Claim Manager is 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. Responsibilities include, but are not limited to, successful achievement of team quality, production and service expectations, staff development, successful implementation of new clients into the Unit, and retention of existing clients. The Manager is responsible for answering complex or difficult claim or customer service questions, advising team members regarding claim processing or customer service procedures, and providing support to ensure all department goals are met. The Manager is expected to have greater visibility and accountability than a Claim Supervisor. This 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. ** This is a Telecommute (Remote) role. Candidates must live within the following states: IL, IN, IA, KS, MO, MT, NM, NC, OK, PA, TN, TX or WI** Sponsorship is not available Required Job Qualifications: 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 Job Qualifications: 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 **This is a Telecommute (Remote) role. Candidates must live within the following states: IL, IN, IA, KS, MO, MT, NM, NC, OK, PA, TN, TX or WI** Sponsorship is not available #LI-NR1 #LI-Remote Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process! EEO Statement: 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: $48,500.00 - $91,000.00 Exact compensation may vary based on skills, experience, and location. Join our talent community and receive the latest Luminare Health news, content, and be first in line for new job opportunities. Join our Talent Community. We help our clients and brokers design custom self-funded Luminare Health plans that manage costs—without compromising benefits—by offering innovative solutions, flexibility, complete data transparency, and member-centered support. We rely on our decades of industry experience and proven, data-driven results to deliver optimal benefits solutions, customized to meet our clients’ needs.

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Responsibilities

The Claim Manager oversees the daily management of Claim Analysts and outsourced vendor staff to meet client and corporate commitments. Responsibilities include achieving team quality and production expectations, staff development, and addressing complex claim or customer service inquiries.