Appeals Coordinator

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.

The Appeals Coordinator processes and documents all aspects of appeal cases including receipt date and time of an appeal, full investigation of the substance of the appeal and any records, written comments or information pertaining to the appeal. This position requires understanding standards set forth by the National Committee for Quality Assurance (NCQA), the Utilization Review Accreditation Commission (URAC), Department of Labor (DOL), Centers for Medicare and Medicaid Services (CMS), Federal and State laws. The Appeals Coordinator position is accountable for understanding Member and Provider Rights and Responsibilities and structure surrounding claims and appeals. The Appeals Coordinator interfaces with members, providers and clients. The Appeals Coordinator is responsible for assisting the Appeals Specialists with the day-to-day operations of the Appeals Department.

• →Appeals Administration
  
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    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.

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    Monitor appeal workflows and turnaround times, while ensuring complete, accurate case documentation and supporting timely resolution of cases.

• →Collaboration & Communication
  
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    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.

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    Communicate effectively with members, providers, health plans, and internal stakeholders, escalating issues as needed to support timely resolution and positive outcomes.

• →Compliance & Quality
  
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    Maintain compliance with NCQA, URAC, CMS, DOL, and federal, state, and local regulations while adhering to organizational policies, ethical standards, and confidentiality requirements.

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    Consistently meet productivity, accuracy, and turnaround time goals for appeal cases while upholding company values and compliance expectations.

• Required Qualifications
  • 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.

Living our Values:

• • Serving everyone with compassion and leading with empathy.
  • Stepping up and creating value by taking charge and acting when there is an opportunity.
  • Adapting in a changing world by recognizing our responsibility to be agile and respond quickly.
  • Nurturing growth and belonging by respecting and celebrating everyone for who they are.

Competencies

• • 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.

Working Conditions:

• • Work is performed from home with company-provided equipment. Sitting for long periods of time is expected and use of fingers and hands for typing is necessary.
  • A quiet workspace with minimal background noise for calls.
  • High-speed internet service (cable or fiber optic) with minimum download Speed of 20 Mbps, Upload Speed of 5 Mbps, and Maximum Latency of 100 milliseconds (must be installed before starting) required.
  • Frequent use of computer and phone systems
  • Must be able to constantly remain in a stationary, sitting position, communicate and exchange information with others, inspect information, perform repetitive motions with arms and fingers, interpret data, problem solve, make decisions, organize and plan, and maintain a positive and professional attitude in all situations.
  • Travel between multiple residences or remote work locations is not supported for this position; employees must establish and work consistently from a single designated home office.

We encourage applicants from a variety of backgrounds and experiences to apply, especially those who can demonstrate how their unique qualifications and skills align with the requirements of this role and support our mission to improve whole-person health.

This position will accept and review new applications and resumes no less than 5 business days after the original posting date and may remain open an extended period of time with no set end date based on the level of interest.