Appeals Coordinator

Lucet•,

6d•$22 - $24•Remote

About The Position

At Lucet, we’re transforming whole-person care. We deliver integrated behavioral and physical health solutions that connect individuals to the right care at the right time—improving outcomes and overall well-being. Serving over 15 million lives across the U.S. and Puerto Rico, our model combines clinical expertise, compassionate care, and innovative technology to support healthier, more fulfilling lives. As part of the Lucet team, employees join a mission-driven organization committed to making a lasting impact. Whether through behavioral health navigation, in-home medical care, or 24/7 crisis support, our work is rooted in empathy, collaboration, and a shared passion for helping people thrive. At Lucet, we’re committed to creating a workplace where top talent thrives both personally and professionally. We offer a dynamic, mission-driven environment where your work has real impact, your unique background and experience are valued, and no two days are alike. If you’re passionate about meaningful work and delivering impactful results, we encourage you to apply! At Lucet, your work will directly support our mission to improve behavioral, physical, and social health—one member at a time.

Requirements

Associates degree and 1+ year of relevant healthcare experience. Equivalent combination of education and relevant healthcare appeals, claims, utilization management, or health plan experience may be considered in lieu of a degree including high school diploma with 3+ years’ of relevant healthcare experience.
1+ years of healthcare appeals, claims, utilization management or related health plan experience.
Proficient in Microsoft Office (Word, Excel, Outlook. Etc.) and appeals documentation system
Demonstrated knowledge of applicable federal and state regulations, accreditation standards, privacy, confidentiality, and security requirements related to healthcare information.
Ability to pass background check upon hire and throughout employment to include criminal felony & misdemeanor search, SSN validation/trace search (LEIE), education report (highest degree obtained), civil upper and lower search, 7-year employment report, federal criminal search, statewide criminal search, widescreen plus national criminal search, health care sanctions-state med (SAM), national sex offender registry, prohibited parties (OFAC) (terrorist watchlist), and a 10-Panel Drug Screen.
Demonstrated flexibility and adaptability to changing processes and various software programs.
Ability to manage multiple priorities in a fast-paced environment
Professional demeanor and ability to work collaboratively with multiple levels of professionals and line staff
Actively participate in and positively contribute to team processes and lead team activities
Excellent problem-solving, organizational and attention to detail skills.

Responsibilities

Process, research, and document appeals and claims in compliance with regulatory requirements, business rules, and department guidelines to support accurate determinations and issuance of compliant notices.
Monitor appeal workflows and turnaround times, while ensuring complete, accurate case documentation and supporting timely resolution of cases.
Collaborate with Appeals Specialists, customer service, and reimbursement teams to ensure appeals and claims are processed accurately, in compliance with policies, and resolved within required timeframes.
Communicate effectively with members, providers, health plans, and internal stakeholders, escalating issues as needed to support timely resolution and positive outcomes.
Maintain compliance with NCQA, URAC, CMS, DOL, and federal, state, and local regulations while adhering to organizational policies, ethical standards, and confidentiality requirements.
Consistently meet productivity, accuracy, and turnaround time goals for appeal cases while upholding company values and compliance expectations.

Benefits

Hourly compensation between $22.15 to $24, PLUS an annual performance-based, discretionary incentive.
Comprehensive health benefit options: Medical, dental, and vision coverage
401(k) with competitive employer match
Company-paid life and disability insurance
Paid parental leave and wellbeing incentives
Generous paid time off, including volunteer time
Flexible spending accounts for healthcare and dependent care
Professional development opportunities and tuition reimbursement
Remote work flexibility (role-dependent)
Opportunity for meaningful growth, both personally and professionally, where your unique background and experience is welcomed and valued.