Claims Specialist

Luminare Health

. Process and examine medical, life, and disability claims .

Posted 10/15/2026full-timeRemote • United StatesMid-LevelSenior💰 $42,200 - $79,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates extensive experience in medical claims processing, with a strong understanding of PPO reimbursement methodologies, fraud detection, and analytical decision-making. Proven ability to maintain detailed records, manage multiple tasks, and collaborate effectively in a fast-paced, customer service-driven environment.

Highest-signal resume keywords

Medical Claims Processing ExperiencePPO Reimbursement MethodologiesFraud Detection and Abuse PatternsAnalytical and Decision-Making SkillsProficiency in Microsoft Office

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Claims ProcessingCode Review EditsFraud DetectionPPO Reimbursement MethodologiesStop Loss Coverage UnderstandingAnalytical SkillsMathematical SkillsRecord KeepingClaims ExaminingInsurance Claim Knowledge

Soft Skills

Excellent Communication SkillsInterpersonal SkillsOrganizational SkillsCreative Problem SolvingTime Management Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookMicrosoft Access

Industry Keywords

Medical TerminologyClaims ProcessingCustomer ServiceFast-Paced EnvironmentWorkflow Management

About the role

Key responsibilities & impact

Process and examine medical, life, and disability claims
Apply specialized medical claims processing knowledge and code review edits
Identify fraud and abuse patterns
Apply PPO reimbursement methodologies and stop loss coverage understanding
Investigate claims and make analytical, mathematical, and informed decisions
Maintain accurate, detailed records and thoroughly document claim information
Organize workflow, prioritize workloads, manage numerous tasks, and meet deadlines
Handle additional tasks and projects and support other team members
Collaborate with team members, employees, providers, clients, and other departments
Adapt to new systems, policies, environments, and improvement methodologies
Foster a positive team environment
Work in a fast-paced, customer service-driven environment

Requirements

What you’ll need

4 years medical claims processing experience
Comprehensive knowledge of specialized medical claims processing
Understanding of code review edits and fraud and abuse patterns
Excellent verbal and written communication skills
Excellent interpersonal skills
Performance and audit scores of 99% payment, 97% financial, and 97% accuracy or better
Familiarity with various PPO reimbursement methodologies
Basic knowledge and understanding of stop loss coverage
Proficiency in Microsoft Office programs
Exceptional organization skills
Extremely detail oriented
Ability to work effectively with team members, employees, providers, and clients
Ability to work in a fast-paced, customer service driven environment
Strong disability and/or life claim knowledge and understanding of all aspects of claims examining
Solid investigation, analytical, and organizational skills
Attention to detail or equivalent combination of relevant experience
Minimum five years insurance claim experience with an understanding of medical terminology
Strong math and decision-making skills
Ability to keep accurate, detailed records and thoroughly document claim information
Creative problem solving and conflict resolution skills
Ability to organize workflow and accept additional tasks and projects
Strong time management skills
Ability to prioritize workload, manage numerous tasks, and support other team members
Ability to make decisions independently or with minimal supervision
Excellent verbal and written communication skills
Ability to handle pressure, interact effectively with other departments, and meet prescribed deadlines
Ability to adapt to new systems, policies, and environments
Effective use of personal computers and related software
Proficiency with Word, Excel, and Outlook; Access preferred

Benefits

Comp & perks

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
Annual incentive bonus plan subject to the terms and conditions of the plan
Remote work from anywhere within the continental United States, excluding California, New York, Alaska, and Hawaii
Drug-free and smoke-free workplace