Remote Appeals Specialist

Lumeris; United States; Remote; USD 39,000 - 48,000; Full time

Benefits offered by this job

Medical, Vision and Dental Plans

401k with company match

PTO and Paid Time Off

Job summary

Lumeris is hiring an Appeals Coordinator to review, research, and resolve appeals while ensuring compliance with regulations and timelines. The role emphasizes accuracy, documentation, and professional communication with members and providers.

The position is remote in the United States with full-time hours. Responsibilities include preparing case files, writing responses, and identifying process improvements, all within established standards.

Qualifications

• 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

Responsibilities

• Reviews, evaluates, documents, and tracks appeal documents.
• Creates, composes, and provides quality written responses to appeals requests.
• Helps identify areas of improvement for self and the department.
• Prepares case files for Independent Review Entities or other levels of the Appeals process.
• Communicates with members and providers on appeal resolution.
• Performs peer QA of appeal notification letters.
• Ensures compliance with state and federal regulations and guidelines.

Skills

Attention to detail

Communication skills

Multitasking

Learning agility

Professional interaction

Education

High School or equivalent

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

Lumeris is hiring an Appeals Coordinator to review, research, and resolve appeals while ensuring compliance with regulations and timelines. The role emphasizes accuracy, documentation, and professional communication with members and providers.

The position is remote in the United States with full-time hours. Responsibilities include preparing case files, writing responses, and identifying process improvements, all within established standards.