Lumeris

• Model & Tool Development • Design, build, and validate actuarial and analytic models from the ground up • Develop efficient processes to support business operations, financial reporting, and MA PD bids • Formalize and adhere to team standards for model design and work quality • Continuously refine and improve models based on emerging data and business needs • One-Off & Strategic Analytics • Perform deep-dive, ad hoc analyses to answer complex business questions, displaying high degrees of mathematical rigor and common sense • Translate ambiguous business problems into structured analytical methodologies • Present findings clearly to both technical and non-technical stakeholders to influence business decisions • Own and manage analytic projects from planning to communication of results.

Role Description The Senior Actuarial Analyst is a high-learning, high-ownership position responsible for working independently to develop subject matter expertise across multiple actuarial areas. This role focuses on designing and building net-new analytical tools and frameworks that directly support executive decision-making across various functions (e.g., pharmacy, risk adjustment, benefit analysis, etc.). Operate as an internal consultant — partnering with senior leaders to understand their business needs, then building the SQL and Excel-based tools that help them meet measurable goals. Success requires strong analytical curiosity, rigorous critical thinking, a coder's mentality, and a genuine commitment to getting things right. Qualifications - Bachelor's degree in a relevant field or equivalent - 5+ years of relevant experience or the knowledge, skills, and abilities to succeed in the role - Intermediate SQL skills — the ability to write precise, well-documented, complex queries is essential - Strong Excel proficiency; experience with SAS or similar tools a plus - Actuarial exam progress (ASA in process) preferred but not required - Demonstrated ability to build analytical tools from scratch in ambiguous or unstructured environments - Strong communication skills — ability to interview an executive stakeholder, understand their goals, and translate them into an analytical specification - Openness to coaching, close collaboration, and iterative feedback during onboarding - A genuine standard of quality — someone who notices when something doesn't look right and takes the time to figure out why Requirements - Design, build, and validate actuarial and analytic models from the ground up - Develop modular SQL code and Excel-based tool suites that run on a regular cadence - Build tools that put actionable outputs directly in the hands of the executives - Formalize and adhere to team standards for model design, code documentation, and work quality - Continuously refine and improve models based on emerging data and business needs - Perform deep-dive, ad hoc analyses to answer complex business questions - Translate ambiguous business problems into structured analytical methodologies - Present findings clearly to both technical and non-technical stakeholders - Own and manage analytic projects from planning through delivery Benefits - Medical, Vision and Dental Plans - Tax-Advantage Savings Accounts (FSA & HSA) - Life Insurance and Disability Insurance - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) - Employee Assistance Program - 401k with company match - Employee Resource Groups - Employee Discount Program - Learning and Development Opportunities - And much more...

Role Description The Senior Talent Advisor serves as a strategic partner to the business—moving beyond traditional recruiting to shape workforce strategy, strengthen organizational capability, and deliver measurable talent outcomes. This role aligns talent strategies to enterprise priorities, brings forward-looking market insight, and designs solutions that help the business hire faster, hire better, and stay competitive. Primary responsibilities - Strategic talent partnership: Build deep alignment with business leaders to understand priorities, goals, and long-term workforce needs. Shape talent strategies that directly support business outcomes—improving both the speed and quality of hiring. Act as a trusted advisor, bringing perspective and insight that influence decisions at the highest levels. - Workforce planning and forecasting: Partner with leaders to assess current and future talent needs. Identify gaps, model scenarios, and shape build, buy, or borrow strategies aligned to business direction. - Market intelligence and insight: Use labor market data, competitive intelligence, and internal analytics to inform hiring strategies, strengthen talent positioning, and guide compensation alignment. - Consultative advisory: Operate as a true thought partner. Challenge assumptions, offer clear recommendations, and guide leaders through complex talent decisions using data and expertise. - Customized talent strategies: Design tailored sourcing strategies for critical and complex roles. This includes segmentation, talent mapping, and proactive pipelining aligned to future needs. - Stakeholder influence: Influence hiring practices, selection strategies, and decision-making to improve quality of hire, reduce time to fill, and strengthen overall outcomes. - Talent experience strategy: Create a thoughtful, differentiated experience for candidates and stakeholders—from first interaction through offer and onboarding. - Continuous improvement and innovation: Identify opportunities to improve how we find, engage, and hire talent. Leverage new tools, including AI, to drive efficiency and better outcomes. - Cross-functional collaboration: Partner closely with People Business Partners, Total Rewards, and business leaders to deliver integrated, high-impact talent solutions. Qualifications - Bachelor’s degree or equivalent experience - 5+ years of progressive experience in talent acquisition, talent consulting, or workforce strategy in a complex, fast-paced environment - Demonstrated ability to operate as a strategic advisor—not an execution-focused recruiter - Proven ability to identify, attract, and close hard-to-find talent in highly competitive markets - Strong experience using market data, competitive intelligence, analytics, and business insights to influence talent decisions and improve outcomes - Demonstrated proficiency leveraging AI or other technologies to improve sourcing strategies and hiring efficiency - Proven track record of influencing leadership, hiring teams, and senior stakeholders to drive talent outcomes - Exceptional critical thinking, problem-solving, and consultative skills - Strong communication skills, business acumen, and executive presence - Experience designing innovative sourcing and talent strategies for complex or novel roles - Ability to operate effectively in ambiguity and align multiple stakeholders to a unified strategy Requirements - While performing the duties of this job, the employee works in normal office working conditions. Benefits - Medical, Vision and Dental Plans - Tax-Advantage Savings Accounts (FSA & HSA) - Life Insurance and Disability Insurance - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) - Employee Assistance Program - 401k with company match - Employee Resource Groups - Employee Discount Program - Learning and Development Opportunities - And much more...

Title: Patient Engagement Specialist Location: Remote, USA time type: Full time job requisition id: R0007004 Job Description: Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Patient Engagement Specialist Position Summary: Responsible for engaging patients to schedule, coordinate and optimize in-home and virtual health assessments. Supports outreach efforts to improve population health management, including cost, quality, access, network optimization, and general principles of documentation and coding. Supports and impacts the success of the program by engaging patients to promote adoption of health assessments. Job Description: Primary Responsibilities - Completes outreach to patients telephonically to engage, promote, and schedule house calls visits, either in the home, in-office or virtual appointments. - Maintains targeted call averages and other key metrics that ensure program success and volume goals are met. - Provides patient education on purpose of the assessment, benefits and available services and screenings. - Assists patient/family with scheduling appointments with appropriate providers/staff; and coordination of durable medical equipment (DME) and supplies. - Follows established protocols. Escalates urgent and/or life-threatening concerns appropriately. - Leverages engagement and other soft skills to ensure patient satisfaction. - Connects patients to appropriate resources based on identified needs, such as Case Management or Customer Service. - Understands market practices and collaborates to achieve population health initiatives. - Performs other duties as assigned. Qualifications - Associate’s in healthcare related field, LPN, or equivalent with advanced training - 1+ years of strong telephonic outreach or the knowledge, skills, and abilities to succeed in the role - Healthcare experience preferred - Ability to operate in a fast-paced and dynamic environment - Effective communication skills with the ability to interact with multi-disciplinary teams and patients - Good time-management and project management skills, including the ability to plan, interpret basic processes/programs, escalate issues in a timely fashion, and ensure adherence to timelines - Strong organization and customer service skills, detail-oriented, and ability to consistently meet and track timelines and goals ​Working Conditions - Ability to lift up to 20lbs. Moving lifting or transferring of patients may involve lifting of up to 50lbs as well as assist with weights of more than 100lbs. Ability to stand for extended periods. #LI-Remote Pay Transparency: Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements. The hiring range for this position is: $39,000.00-$48,150.00 Benefits of working at Lumeris - Medical, Vision and Dental Plans - Tax-Advantage Savings Accounts (FSA & HSA) - Life Insurance and Disability Insurance - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) - Employee Assistance Program - 401k with company match - Employee Resource Groups - Employee Discount Program - Learning and Development Opportunities - And much more... Be part of a team that is changing healthcare! Member Facing Position: Location: Remote, USA Time Type: Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Disclaimer: The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities.

Role Description Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines. - Reviews, evaluates, documents, and tracks appeal documents. - Follows request through resolution by established processes and procedures, and within established time standards. - Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards. - Helps identify areas of improvement for self and the department. - Prepares case files for Independent Review Entities or other levels of the Appeals process. - Communicates with members and providers on appeal resolution. - Performs peer QA of appeal notification letters. - Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities. Qualifications - High School or equivalent. - 1+ years Appeals related experience or the knowledge, skill, abilities to succeed in the role. - Strong learning agility and enthusiastic about developing new skills. - Ability to interact professionally and maintain confidentiality and high ethical standards. - Ability to multi-task, meet deadlines, and adapt to changing priorities. - Solid oral and written communication skills. - Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook. - Solid attention to detail. Requirements - While performing the duties of this job, the employee works in normal office working conditions. - Work weekends and company holidays as needed based on business regulatory requirements. Benefits - Medical, Vision and Dental Plans. - Tax-Advantage Savings Accounts (FSA & HSA). - Life Insurance and Disability Insurance. - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days). - Employee Assistance Program. - 401k with company match. - Employee Resource Groups. - Employee Discount Program. - Learning and Development Opportunities. - And much more...

• Design, build, and maintain pharmacy analytic assets, including dashboards, data extracts, recurring performance views, and executive-ready reporting products across medication adherence, Part D quality, and cost trends. • Translate pharmacy business requirements into auditable analytic logic, including adherence calculations, drug hierarchy assumptions, and opportunity sizing. • Analyze multi-source data (PBM/Rx claims, medical claims, eligibility, clinical) to establish baselines, detect trends, and uncover root causes of performance gaps in areas like medication adherence and 90-day prescription adoption. • Partner with Pharmacy, Clinical, Finance, and Operations stakeholders to prioritize high-impact opportunities and convert analytic insights into intervention targeting and measurable performance improvement. • Automate and scale recurring pharmacy reporting to reduce manual effort through scalable dashboards, reusable SQL, documented logic, and repeatable processes. • Create and manage validation routines, QA checks, and reconciliation processes to ensure pharmacy reporting is accurate, trusted, reproducible, and audit-ready. • Translate complex pharmacy, PBM, and financial logic into clear, decision-ready performance narratives for non-technical stakeholders and health plan leadership. • Serve as a senior subject matter expert on Medicare Advantage pharmacy analytics, PBM/Rx claims data, Part D quality measures, and formulary concepts.

• Design, build, and maintain CMS-aligned Stars/HEDIS analytic assets, including dashboards, data extracts, recurring performance views, and executive-ready reporting products. • Translate measure specifications (numerator, denominator, exclusions) into auditable analytic logic and develop member-, provider-, and measure-level views to guide Quality Improvement actions. • Analyze multi-source data (quality, medical, pharmacy, clinical) to establish baselines, detect trends, uncover root causes of performance gaps, and distinguish data issues from operational issues. • Partner with Quality Improvement, Clinical, Pharmacy, and Operations stakeholders to prioritize high-impact opportunities and convert analytic insights into intervention targeting, workflow integration, and measurable gap closure. • Automate and scale recurring quality reporting to reduce manual effort through scalable dashboards, reusable SQL, documented logic, and repeatable processes. • Create and manage validation routines, QA checks, and reconciliation processes to ensure quality reporting is accurate, trusted, reproducible, and audit-ready. • Translate complex technical and measure logic into clear, decision-ready performance narratives for non-technical stakeholders and health plan leadership. • Serve as a senior subject matter expert on Stars, HEDIS, quality measure reporting, and health plan operations, advising on the workflow integration of analytic insights.

• Oversee the day-to-day operations of the AP and AR/Premium Billing functions. • Manage and develop a team, providing guidance, training, and performance feedback to ensure departmental goals are met. • Oversee all accounts payable processes, including vendor invoice processing, provider claims payment processing, and commission payments, ensuring accuracy and timeliness. • Drive enhancements to the AP/invoicing platform to increase efficiency and improve the customer experience. • Own and manage the entire member/group premium billing cycle, including invoicing, collections, cash posting, and reconciliations. • Oversee the application of payments from various sources (lockbox, EFT, member portal), ensuring accuracy and timeliness. • Manage the collections process for outstanding receivables, including the relationship with the collection agency. • Identify opportunities for process improvements and workflow automation within the AP and AR cycles. • Serve as the business lead for system enhancements, including performing User Acceptance Testing (UAT). • Ensure compliance with all relevant regulations, including CMS, State DOI, and HIPAA. • Serve as the subject matter expert and business owner for all audits (Financial, SOX, State, Federal) related to AP and AR/Premium Billing, including managing evidence requests.

Appeals Coordinator locations Remote, USA time type Full time job requisition id R0007005 Your Future is our Future At Lumeris, we believe that our greatest achievements are made possible by the talent and commitment of our team members. That's why we are actively seeking talented and collaborative individuals who are passionate about making a difference in the healthcare industry. Join us today as we strive to create a system of care that every doctor wants for their own family and become part of a community that values its people and empowers you to make an impact. Position: Appeals Coordinator Position Summary: Responsible for reviewing, researching, and resolving appeals. Escalates complex appeals as needed. Ensures compliance with all applicable regulations, standards, timelines, policies, and guidelines. Job Description: Primary Responsibilities - Reviews, evaluates, documents, and tracks appeal documents.  Follows request through resolution by established processes and procedures, and within established time standards. - Creates, composes, and provides quality written responses (applying the appropriate composition, grammar, punctuation, and spelling) to appeals request within established time standards. - Helps identify areas of improvement for self and the department. - Prepares case files for Independent Review Entities or other levels of the Appeals process. - Communicates with members and providers on appeal resolution. - Performs peer QA of appeal notification letters. - Ensures compliance with all state and federal regulations (Center for Medicare and Medicaid Services, National Committee for Quality Assurance) and guidelines with day to day activities. Qualifications - High School or equivalent - 1 + years Appeals related experience or the knowledge, skill, abilities to succeed in the role - Strong learning agility and enthusiastic about developing new skills - Ability to interact professionally and maintain confidentiality and high ethical standards - Ability to multi-task, meet deadlines, and adapt to changing priorities - Solid oral and written communication skills - Good computer skills, specifically with Microsoft Word, Excel, PowerPoint, and Outlook - Solid attention to detail Working Conditions - While performing the duties of this job, the employee works in normal office working conditions - Work weekends and company holidays as needed based on business regulatory requirements #LI-Remote Pay Transparency: Factors that may be used to determine your actual pay rate include your specific skills, experience, qualifications, location, and comparison to other employees already in this role. In addition to the base salary, certain roles may qualify for a performance-based incentive and/or equity, with eligibility depending on the position. These rewards are based on a combination of company performance and individual achievements. The hiring range for this position is: $39,000.00-$48,150.00 Benefits of working at Lumeris - Medical, Vision and Dental Plans - Tax-Advantage Savings Accounts (FSA & HSA) - Life Insurance and Disability Insurance - Paid Time Off (PTO, Sick Time, Paid Leave, Volunteer & Wellness Days) - Employee Assistance Program - 401k with company match - Employee Resource Groups - Employee Discount Program - Learning and Development Opportunities - And much more... Be part of a team that is changing healthcare! Member Facing Position: No- Not Member or Patient Facing Position Location: Remote, USA Time Type: Full time Lumeris and its partners are committed to protecting our high-risk members & prospects when conducting business in-person. All personnel who interact with at-risk members or prospects are required to have completed, at a minimum, the initial series of an approved COVID-19 vaccine. If this role has been identified as member-facing, proof of vaccination will be required as a condition of employment. Disclaimer: - The job description describes the general nature and level of work being performed by people assigned to this job and is not intended to be an exhaustive list of all responsibilities, duties and skills required. The physical activities, demands and working conditions represent those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individual with disabilities to perform the essential job duties and responsibilities. Lumeris is an EEO/AA employer M/F/V/D.

• Build the marketing measurement ecosystem from the ground up, defining the tools, data requirements, and processes needed to move beyond platform-reported metrics. • Lead the selection and implementation of an MMM solution and use it as the primary framework for budget allocation. • Establish a structured testing program to measure what marketing is actually driving. • Assess and implement attribution capabilities where they add value. • Own marketing performance frameworks, ensuring consistent and accurate evaluation across all channels and campaigns. • Develop marketing-driven forecasts for leads, calls, and enrollments aligned to campaign strategy. • Translate marketing analytics needs into clear data requirements. • Define and enforce campaign structures, channel hierarchies, and marketing-specific definitions.