Appeals Coordinator

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $39k - $48.1k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Lumeris

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

☁️ SaaS

Healthcare • Healthcare Insurance • SaaS

Lumeris is a company focused on providing value-based care solutions within the healthcare industry. With over a decade of leadership in this field, Lumeris partners with health systems to improve patient outcomes and drive financial success through tech-enabled solutions. Their platform supports population health management, clinical delivery transformation, and payer contracting, offering comprehensive solutions for acute, post-acute, and high-risk patient management. Lumeris is recognized for creating significant cost savings and achieving excellent patient outcomes, including a 5-star CMS rating for its Medicare Advantage Prescription Drug Plan.

📋 Description

• Review, evaluate, document, and track appeal documents • Follow requests through resolution according to established processes, procedures, and time standards • Create, compose, and provide quality written responses to appeal requests • Identify areas of improvement for self and the department • Prepare case files for Independent Review Entities or other levels of the Appeals process • Communicate with members and providers regarding appeal resolution • Perform peer QA of appeal notification letters • Ensure compliance with applicable state and federal regulations, standards, timelines, policies, and guidelines • Work weekends and company holidays as needed based on business regulatory requirements

🎯 Requirements

• High School or equivalent • 1+ years Appeals related experience or the knowledge, skill, abilities to succeed in the role • Strong learning agility and enthusiastic about developing new skills • Ability to interact professionally and maintain confidentiality and high ethical standards • Ability to multi-task, meet deadlines, and adapt to changing priorities • Solid oral and written communication skills • Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook • Solid attention to detail • Authorized to work in the United States • Unable to sponsor visas for this role

🏖️ Benefits

• Medical, Vision and Dental Plans • Tax-Advantage Savings Accounts (FSA & HSA) • Life Insurance and Disability Insurance • Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) • Employee Assistance Program • 401k with company match • Employee Resource Groups • Employee Discount Program • Learning and Development Opportunities • Performance-based incentive and/or equity may apply to certain roles