{"id":3156661,"url":"https://alion.io/job/lumeris-appeals-coordinator","title":"Appeals Coordinator","company":{"id":1828167,"name":"Lumeris","domain":"lumeris.com","url":"https://alion.io/company/lumeris","size_band":null,"is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":null},"role":"Administrative","role_family":"Administrative","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"posting_text","remote_working_hours":null,"hiring_geo_confidence":"explicit","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":39000,"max":48150,"currency":"USD","period":"year","gross":null,"usd_annual":48150},"salary_estimate":null,"experience_years_min":1,"visa_sponsorship":true,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Outlook","optional":false}],"status":"live","first_seen_at":"2026-10-23T14:46:34Z","employer_posted_date":"2026-10-23","last_verified_at":"2026-10-23T20:00:55Z","board_verified":true,"closed_at":null,"days_open":1,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":1},"description":"Your Future is our Future\nAt Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact.\nWe're excited to consider every qualified candidate authorized to work in the United States, although we are unable to sponsor visas for this role at this time.\nPosition:\nAppeals CoordinatorPosition Summary:\nResponsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines.Job Description:\nPrimary Responsibilities\nReviews, evaluates, documents, and tracks appeal documents. Follows request through resolution by established processes and procedures, and within established time standards.\nCreates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards.\nHelps identify areas of improvement for self and the department.\nPrepares case files for Independent Review Entities or other levels of the Appeals process.\nCommunicates with members and providers on appeal resolution.\nPerforms peer QA of appeal notification letters.\nEnsures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities.\nQualifications\nHigh School or equivalent\n1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role\nStrong learning agility and enthusiastic about developing new skills\nAbility to interact professionally and maintain confidentiality and high ethical standards\nAbility to multi-task, meet deadlines, and adapt to changing priorities\nSolid oral and written communication skills\nGood computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook\nSolid attention to detail\nWorking Conditions\nWhile performing the duties of this job, the employee works in normal office working conditions\nWork weekends and company holidays as needed based on business regulatory requirements\n#LI-Remote\nPay Transparency:\nFactors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements.\nThe hiring range for this position is:\n$39,000.00-$48,150.00Benefits of working at Lumeris\nMedical, Vision and Dental Plans\n\nTax-Advantage Savings Accounts (FSA & HSA)\n\nLife Insurance and Disability Insurance\n\nPaid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days)\n\nEmployee Assistance Program\n\n401k with company match\n\nEmployee Resource Groups\n\nEmployee Discount Program\n\nLearning and Development Opportunities\n\nAnd much more...\n\nBe part of a team that is changing healthcare!\nMember Facing Position:\nNo- Not Member or Patient Facing PositionDrug Screen Requirement:\nNoMVR Required:\nNoCredit Check Required:\nNoLocation:\nRemote, USATime Type:\nFull timeLumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment.\nDisclaimer:\nThe job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.\n\nLumeris is an EEO/AA employer M/F/V/D.","description_format":"text","description_chars":4548,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":null,"security_clearance":false,"languages":[]},"benefits":["401k plan","Equity","Life insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Care Coordination & Population Health"],"lifecycle":[{"event":"open","at":"2026-10-23T14:46:34Z"}],"visa":[],"liveness":{"score":90,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.903,"p_room":1,"age_days":0,"expected_fill_days":34,"reasons":["conf:10","velocity","win:early","comp:junior"],"computed_at":"2026-10-24T06:02:35Z"},"pay":{"stated_usd_annual":48150,"is_top_pay":false},"html_url":"https://alion.io/job/lumeris-appeals-coordinator","json_url":"https://alion.io/job/lumeris-appeals-coordinator.json","meta":{"generated_at":"2026-10-24T17:37:00Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"assistant_verified","counted_by":"address","units_charged":1,"used_today":3244,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-10-25T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.02,"usd":0.002,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":1828167},"rest":"https://alion.io/mcp/rest/get_company?id=1828167"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Flumeris-appeals-coordinator"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"live","price":{"credits":1,"usd":0.1},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Flumeris-appeals-coordinator"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.02,"usd":0.002},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Flumeris-appeals-coordinator"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/lumeris-appeals-coordinator\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Flumeris-appeals-coordinator"}]}