Grievance and Appeals Specialist

Job not on LinkedIn

🔥 36 minutes ago

🏈 Alabama, Arizona, +40 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $18 - $33 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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Luminare Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Luminare Health is a leading provider of self-funded health plan administration services with over 50 years of industry experience. The company specializes in offering flexible and innovative solutions for hospitals, health systems, and direct-to-employer initiatives, focusing on administration, cost management, and digital reporting tools. Luminare Health is dedicated to being a reliable partner in managing healthcare costs and supporting strategic growth for its clients. The company emphasizes a member-centered approach to healthcare while delivering significant savings through expert claim analysis and management of high-cost claims.

📋 Description

• Address and handle appeals received within specified timeframes to meet contractual obligations • Maintain, revise, and implement policies and procedures • Ensure compliance with applicable regulatory standards and contractual obligations • Work with employees/members, providers, co-workers, and staff at all levels • Read and interpret documents, criteria, instructions, and policy and procedure manuals • Evaluate problems, develop alternative solutions, and identify trends and patterns • Address time-sensitive assignments through organization and prioritization • Work independently with minimal supervision in a dynamic, team-oriented environment

🎯 Requirements

• High School Diploma or GED • Minimum two years of medical claims experience in a health insurance environment • Thorough working knowledge of Medicare, CMS guidelines, plan policies, and claims determination • Demonstrated problem solving skills, including critical thinking and investigation • Proficient with MS Suite including Word, Excel, and Outlook • Ability to work in a fast-paced, customer service and production-driven environment • Excellent verbal and written communication skills • Ability to work effectively with employees/members, providers, differing levels of co-workers, and all levels of staff • Ability to read and interpret documents, criteria, instructions, and policy and procedure manuals • Ability to apply common sense understanding to written, oral, or diagram-form instructions • Ability to evaluate problems, develop alternative solutions, and identify trends and patterns • Organization and prioritization skills for time-sensitive assignments • High level of confidentiality, flexibility, and willingness to learn new tasks • Ability to work in a dynamic team-oriented environment • Ability to work independently with minimal supervision or instruction • Previous experience with core operations preferred in a healthcare claims environment • Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, and New York

🏖️ Benefits

• 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