Job Overview
Location
Work From Home (HB)
Job Type
Full-time
Category
Operations
Date Posted
May 13, 2026
Full Job Description
đź“‹ Description
- • The Claims Analyst is responsible for the accurate adjudication and processing of medical, dental, vision, or other related claims, including related correspondence and/or electronic inquiries for assigned groups, ensuring compliance with plan documents, claim processing guidelines, and established turnaround times.
- • Day-to-day responsibilities include reviewing, analyzing, and interpreting claim forms and related documents (80% of time), determining benefit coverage using clinical edits, plan documents, and reference materials, investigating and referring claims as needed, handling correspondence within performance guarantees, and supporting the Claims reinsurance team in research and resolution of claims.
- • The role also involves supporting internal departments in claims research and resolution (15% of time), communicating via telephone, email, electronic messaging, fax, or written letter with employees/members, providers, clients, and other insurance carriers to ensure proper claim processing, and performing other duties as assigned (5% of time). Additional responsibilities include customer service—responding to high-volume phone calls within time specifications, resolving issues through effective communication—and resource development/training, such as training Claims Assistants, updating procedural manuals, and providing team back-up.
- • At Luminare Health, part of Health Care Service Corporation (HCSC), employees are empowered with curated development plans that foster growth and promote rewarding, fulfilling careers. HCSC is a purpose-driven company that invests in professional development, offering a supportive environment where employees are valued as the cornerstone of business success.
- • In this role, the individual can develop expertise in claims adjudication, gain deep knowledge of health insurance benefits and plan documents, strengthen communication and problem-solving skills, become proficient in proprietary systems and MS Office tools, and contribute to process improvements while building a foundation for career advancement in healthcare operations or insurance processing.
🎯 Requirements
- • High School diploma or GED equivalent
- • Ability to work in a fast-paced, customer centric and production driven environment
- • Effective verbal and written communication skills
- • Ability to work effectively with team members, employees/members, providers, and clients
- • Ability to use common sense understanding to carry out instructions furnished in oral, written or diagram form
- • 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
Skills & Technologies
About Health Care Service Corporation
Health Care Service Corporation is the largest customer-owned health insurer in the United States, operating Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. It provides medical, dental, vision, life, and disability coverage to nearly 17 million members through individual, employer, and government programs. The company emphasizes community health investments, digital services, and value-based care initiatives. Founded in 1936 and headquartered in Chicago, HCSC is licensed as a mutual legal reserve company and governed by its policyholders.
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