Remote Appeals Specialist - Precise & Impactful

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

Benefits offered by this job

Medical, Vision and Dental Plans

Tax-Advantage Savings Accounts (FSA &H

Life Insurance and Disability

Paid Time Off (PTO, Sick Time, Paid LE

401k with company match

Learning and Development Opportunities

Employee Discount Program

Job summary

Lumeris is seeking an Appeals Coordinator for a remote, United States-based role. You will review, research, and resolve appeals, ensuring compliance with regulations and deadlines.

You will handle documentation, communications with members and providers, and prepare case files across the appeals workflow. The position emphasizes accuracy, confidentiality, and professional communication, with opportunities to contribute to process improvements across the department.

Qualifications

• 1+ year of 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.
• Follows request through resolution by established processes and procedures, and within established time standards.
• Creates, composes, and provides quality written responses to appeals request within established time standards.
• 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

Communication skills

Attention to detail

Confidentiality

Time management

Multi-tasking

Microsoft Office proficiency

Education

High School Diploma or equivalent

Tools

Microsoft Word

Microsoft Excel

PowerPoint

Outlook

Job description

Lumeris is seeking an Appeals Coordinator for a remote, United States-based role. You will review, research, and resolve appeals, ensuring compliance with regulations and deadlines.

You will handle documentation, communications with members and providers, and prepare case files across the appeals workflow. The position emphasizes accuracy, confidentiality, and professional communication, with opportunities to contribute to process improvements across the department.