Grievance and Appeals Specialist

Luminare Health

. Address and handle appeals received within specified timeframes to meet contractual obligations .

Posted 9/25/2026full-timeRemote • United StatesJuniorMid-Level💰 $18 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical claims processing, including thorough knowledge of Medicare and CMS guidelines, while effectively communicating and collaborating with diverse stakeholders in a fast-paced environment.

Highest-signal resume keywords

Medical Claims ExperienceMedicare KnowledgeProblem Solving SkillsMS Suite ProficiencyPolicy Interpretation

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Medical Claims ProcessingMedicare GuidelinesClaims DeterminationPolicy ImplementationCritical Thinking

Soft Skills

Verbal CommunicationWritten CommunicationOrganization SkillsTeam CollaborationFlexibility

Tools & Technologies

MS WordMS ExcelMS Outlook

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Health InsuranceCMS GuidelinesRegulatory ComplianceConfidentialityCustomer Service

About the role

Key responsibilities & impact

Address and handle appeals received within specified timeframes to meet contractual obligations
Maintain, revise, and implement policies and procedures
Ensure compliance with applicable regulatory standards and contractual obligations
Work with employees/members, providers, co-workers, and staff at all levels
Read and interpret documents, criteria, instructions, and policy and procedure manuals
Evaluate problems, develop alternative solutions, and identify trends and patterns
Address time-sensitive assignments through organization and prioritization
Work independently with minimal supervision in a dynamic, team-oriented environment

Requirements

What you’ll need

High School Diploma or GED
Minimum two years of medical claims experience in a 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, and Outlook
Ability to work in a fast-paced, customer service and production-driven environment
Excellent verbal and written communication skills
Ability to work effectively with employees/members, providers, differing levels of co-workers, and all levels of staff
Ability to read and interpret documents, criteria, instructions, and policy and procedure manuals
Ability to apply common sense understanding to written, oral, or diagram-form instructions
Ability to evaluate problems, develop alternative solutions, and identify trends and patterns
Organization and prioritization skills for time-sensitive assignments
High level of confidentiality, flexibility, and willingness to learn new tasks
Ability to work in a dynamic team-oriented environment
Ability to work independently with minimal supervision or instruction
Previous experience with core operations preferred in a healthcare claims environment
Remote employees must live within the continental United States, excluding Alaska, California, Hawaii, and New York

Benefits

Comp & perks

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
Annual incentive bonus plan