Job Overview
Location
Work From Home (HB)
Job Type
Full-time
Category
Operations
Date Posted
April 22, 2026
Full Job Description
đź“‹ Description
- • The Claims Auditor role at Luminare Health (HCSC) is critical to ensuring the accuracy and integrity of health plan claim processing, directly supporting operational success and compliance with company and industry quality standards.
- • Day-to-day responsibilities include pre-check run auditing on reports prior to finalizing check runs, assisting with Health Plan claim audits and providing feedback to management and staff, completing Claims Appeals and 095 processes according to guidelines and timeframes, and assisting in establishing and communicating new and existing policies and procedures while recommending workflow improvements and participating in compliance investigations.
- • Luminare Health, part of Health Care Service Corporation (HCSC), is a purpose-driven organization that invests in employee development through curated growth plans, fostering rewarding and fulfilling careers in a supportive, mission-focused environment.
- • In this role, the individual will deepen expertise in healthcare claims auditing, develop strong analytical and process improvement skills, gain experience in compliance and corrective action planning, and contribute to organizational efficiency while building a foundation for advancement in healthcare operations or audit leadership.
🎯 Requirements
- • Bachelor’s degree or equivalent experience required
- • At least 4-5 years of experience in claim processing
- • Specific knowledge of claims and processes in a Commercial BC/BS HMO organization
- • Proficient in MS Office applications: Outlook, Excel, Word, Access, and PowerPoint
- • Extensive knowledge of CPT 4, HCPCS, UB-04, and ICD-10 coding
- • Medical terminology knowledge
- • Excellent interpersonal, oral, and written communication skills
- • Strong attention to detail and organization
- • Able to work independently with strong analytic skills
- • Strong computer skills
- • Flexibility to switch priorities effectively when directed by network leadership
- • Ability to meet deadlines
- • Capability to work in a fast-paced, sometimes stressful environment
🏖️ Benefits
- • Health and wellness benefits
- • 401(k) savings plan
- • Pension plan
- • Paid time off and paid parental leave
- • Disability insurance and supplemental life insurance
- • Employee assistance program
- • Paid holidays
- • Tuition reimbursement
- • Annual incentive bonus plan (subject to plan terms and conditions)
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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