[Hiring] Appeals Coordinator @Lumeris

Role Description

Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines.

Primary 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 all state and federal regulations and guidelines with day to day activities.

Qualifications

• 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

Requirements

• While performing the duties of this job, the employee works in normal office working conditions
• Work weekends and company holidays as needed based on business regulatory requirements
• Remote, USA
• Full time

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
• And much more...