Grievance and Appeals Specialist - LHB

About the role

At Luminare Health, our people are what set us apart. Their expertise, dedication, and passion for service excellence are the foundation of our success. We're committed to helping our employees grow through thoughtful development opportunities, meaningful work, and a culture that values collaboration and continuous improvement. When you join Luminare Health, you join a purpose-driven team focused on making healthcare simpler, better, and more affordable. This is a Telecommute (Remote) role; remote employees must live within the continental United States, excluding Alaska, California, Hawaii, or New York.

Responsibilities

The primary responsibility of the Grievance & Appeal Specialist is to address and handle the appeals received within specified timeframes as required to meet contractual obligations. The Specialist is responsible for the maintenance, revision, and implementation of Policies and Procedures to ensure compliance with applicable regulatory standards and contractual obligations.

Requirements

• High School Diploma or GED
• Minimum two years of medical claims experience in 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, Outlook
• Ability to work in a fast-paced, customer service & production driven environment
• Excellent verbal and written communication skills
• Ability to work effectively with employees/members, providers, and differing levels of co-workers and all levels of staff
• Read and interpret documents, criteria, instructions, and policy & procedure manuals
• Apply common sense understanding to carry out instruction furnished in written, oral or diagram form
• Evaluate problems, develop alternative solutions and identify trends and patterns
• Capable of working in an environment that requires organization and prioritization in order to address time sensitive assignments
• Maintain high level of confidentiality, flexibility and willingness to learn new tasks
• Work in a dynamic team-oriented environment
• Work independently with minimal supervision or instruction

Qualifications

• Previous experience with core operations preferred (in a healthcare claims environment)

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

Pay

Compensation range: $18.07 – $33.92 per hour (annual incentive bonus plan subject to plan terms; exact compensation varies based on skills, experience, and location).