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Lumeris Appeals Monitor, Healthcare in St. Louis, Missouri

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Appeals Monitor, Healthcare

Position Summary:

The Appeals Monitor is responsible for ensuring the appeals processing team is meeting production and quality standards through the timely, regular monitoring of their activities. Additionally, this position monitors critical tasks through the oversight and analysis of various reports. This position is highly collaborative and considered a subject matter expert by all levels within appeals processing.

Job Description:

Role and Responsibilities

  • Monitor all appeal types and tasks assigned to the appeals processing team(s)

  • Provide oversight for critical appeals processing tasks through review and analysis of various reports, including universes

  • Track findings from monitoring activities, analyze data captured, and provide business insights to appeals department leadership

  • Provide procedural clarifications and identify training needs for associates to management

  • Ensure completion of monitoring tasks in accordance with production and quality standards

  • Create thorough documentation related to any findings that arise from monitoring activities

  • Serve as a backup for appeals processing team, as necessary

  • Attend and participate in weekly Case Status Meetings

  • Perform other duties as assigned

Experience, Qualifications, and Education

  • High School diploma or equivalent, with Bachelor’s degree strongly preferred

  • 3-5 years of previous appeals experience , including 2+ years of experience processing all levels of appeals for Lumeris’ clients

  • Excellent oral and written communications skills

  • Demonstrated experience analyzing data to derive business insights

  • Strong time management skills

  • Demonstrated expertise in business applications including the Microsoft Office Suite, Facets (or other claims processing systems), etc.

  • Understanding of Federal, State, and Local healthcare laws and regulations

  • Understanding of Health Plan client benefits as well as workflows and processes related to the processing of appeals

Lumeris is an EEO/AA employer M/F/V/D.


St. Louis, MO

Time Type:

Full time

Join Our Growing Team!

Lumeris is a value-based care managed services operator for health systems and providers seeking extraordinary clinical and financial outcomes. Lumeris aligns providers and payers across populations with technologies, processes, behaviors and information to achieve high-quality, cost-effective care with satisfied consumers — and engaged physicians.

Lumeris with Essence Healthcare, its inaugural client and learning laboratory with more than 60,000 Medicare members in Missouri and Illinois, has averaged a CMS rating of 4.5 Stars for the last ten years and produced the highest consumer and physician satisfaction scores in the industry along with significantly better clinical outcomes and lower costs. For more information, go to www.lumeris.com.

Why Join Lumeris?

At Lumeris, you will be part of team that is focused on solving the nation’s healthcare problem, and you will be able to contribute to our purpose. Our environment is fast-paced, change-oriented and focused on growth and employee engagement. At Lumeris, we know that talent is best utilized when given the opportunity to succeed. That is why we have removed the boundaries that inhibit success and focus on fostering an environment that allows employees to utilize their talents.