United States onlyAt 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.
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Job Summary
This position is responsible for providing leadership and oversight to ensure excellence in claim management, oversight, and administration. Responsibilities include, but are not limited to, successful achievement of client/corporate key performance indicators, network Service level agreements, staff development and succession planning. Works collaboratively with leadership and front line staff to ensure strategic direction, consistent operations, and functional business platform is maintained across all locations and staff.Job Responsibilities:
Coordinating and Executing Deliverables
- Strategically plan, and manage, monitor, track and report performance of the department(s), outsourced vendor and support staff to ensure that exceptional service is achieved on key performance indicators. Oversee delegation of work and adjust plans as needed based on staff availability and business need.
- Oversee related functions and/or support functions, as needed.
- Ensure consistency of service deliverables through collaboration with Customer Service Department peers as well as regular communication and leadership of staff.
- Collaborate with Operations Leader in strategic planning, budgeting, and expense control.
People Leadership and Development
- Oversee or handle personnel matters including mentoring, coaching, motivating, performance management and feedback, recognition, performance evaluation and time tracking of direct and indirect reports.
- Recommend compensation and promotion increases.
- Establish and effectively communicate department goals, objectives, culture and expectations.
- Mentor and develop leaders within the team as well as ensure that those leaders do the same with their staff.
- Collaborate with team to determine staffing needs and succession plans, and take or delegate appropriate action.
- Oversee onboarding and training of new staff and newly promoted staff. Assess ongoing training and development needs and provide opportunities for improvement, as needed.
Claim Management and Support
- Handle increasingly complex claim referrals and over-authority claim audits using internal and external resources as needed. Advise staff or vendor regarding claim processing.
- Oversee resolution of client, member, or provider issues regarding highly visible and increasingly complex claim or service issues.
- Effectively communicate and advise staff on client benefits and unique client handling to ensure proper claim processing. Oversee User Testing to ensure benefits are set-up correctly.
- Oversee review of state/federal legislative and regulatory requirements to determine impact on claim practices. Update and/or implement procedures or documentation, as required.
- Oversee client-initiated audits of processed claims and claims procedures.
- Ensure Appeals are maintained with compliance standards
Enterprise Collaboration and Leadership
- Serve as a change agent and leader within the organization to ensure a positive work environment and adherence to corporate values.
- Assist in establishing and maintaining the culture within Claim Operations.
- Collaborate with staff, as well as enterprise to develop effective policies and procedures. Ensure that policies and procedures are implemented timely and maintained effectively.
- Participate in enterprise wide work teams and projects. Include staff as needed for both their input and development.
- Present recommendations and make decisions on project teams and in meetings on behalf of department.
- Ensure data sets are monitored for staffing, performance, and accurate claims managment
Required Job Qualifications:
- Bachelor’s Degree or 10+ years of related business experience
- Minimum 7 years of medical claims experience in the healthcare/benefits arena
- Minimum 5 years previous management experience
- Strong leadership competence, with proven skills in managing change
- Strong interpersonal and collaboration skills with ability to build consensus and develop solid relationships
- Takes initiative, plans and executes plans well, strategic thinker with ability to multi-task, prioritize, handle pressure and make informed decisions
Preferred Job Qualifications:
- Bachelor’s degree
- Self-Funded Insurance/Benefits and/or TPA experience
- Minimum 5 years previous management experience
- Strong leadership competence, with proven skills in managing change
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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:
$76,300.00 - $143,200.00Exact compensation may vary based on skills, experience, and location.
