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Welcome to a team of caring and passionate people who work each day to meet the needs of our members and clients. At Luminare Health (a subsidiary of Health Care Service Corporation), you will be part of an organization committed to offering custom services to self-funded health benefits plans that manage costs - without compromising benefits - by offering innovative solutions, flexibility, transparency and customer support. This is an exciting time to join our team and enhance our culture that emphasizes caring, diversity and inclusion, mutual respect, collaboration and service to our communities.
Job SummaryThis position is responsible for planning and conducting detailed audits, analyzing programs, conducting training, coaching and managing projects related to quality. Review new business, changes, terminations, claims, customer telephone calls, billing, premium application, and commission processes to assure that: a) Internal controls and Model Audit Rule requirements are adhered to b) Processing is performed timely, accurately, and completely in the appropriate systems, and c) Disability coding and liability decisions are accurate, utilizing all appropriate risk resources.JOB REQUIREMENTS:- Bachelor's degree or equivalent of 4 years of group disability insurance industry job experience.
- Analytical and research skills.
- Disability knowledge of NAIC, ERISA, and state regulations.
- Technical claims expertise and accuracy in product knowledge of life, AD&D, STD, and LTD.
- Technical claims expertise and accuracy in knowledge of group life and disability contracts.
- Ability to work independently and within a team environment.
- Applies best practices and knowledge of internal/external business challenges to improve products, processes, or services.
- Solves complex problems; takes a new perspective on existing solutions to improve performance and efficiency.
- Works to build consensus with internal/external peers in customer, and/or regulatory organizations.
- Proven ability to work well in a high visibility environment.
- Clear and concise written and verbal communication skills.
- Experience in making complex decisions independently, with minimal supervision.
- Organizational and multi-tasking skills to manage daily work load and meet aggressive deadlines and timetables.
- Knowledge of state contract provisions.
- Knowledge with sold case materials, departmental documents.
- PC proficiency to include Word, Excel and lotus Notes.
- Ability to demonstrate flexibility.
- Ability to effectively manage conflict.
- Ability to provide direct and candid feedback effectively while maintaining strong partnerships.
- 1 year of experience in the FDL environment.
- Experience with the following systems: Genelco, Enterprise Content Management (ECM), EAS, DCS, STAR
- Minimum of 2 years of Group Disability claims adjudication background.
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EEO Statement:All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, sexual identity, age, veteran, or disability.
Pay Transparency Statement:
At Luminare Health, you will be part of an organization committed to offering meaningful benefits to our associates to support their life outside of work. From health and wellness benefits, 401(k) savings plan, a minimum of 15 days' of paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, new parent paid leave, tuition reimbursement, plus other incentives, we offer a robust total rewards package for full-time associates.
The salary offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan.
Min to Max Range:
$39,900.00 - $82,200.00HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.