🏢 Company: [Your Company Name]
📍 Location: Remote or On-Site (Specify Location)
🕒 Employment Type: Full-Time
💰 Salary: Competitive | Based on Experience | Benefits Included
🔍 About the Role:
We are looking for a detail-oriented and motivated Appeals Representative to join our healthcare or insurance operations team. In this role, you will be responsible for reviewing, investigating, and processing denied claims and appeals submitted by patients, providers, or insurance carriers. You will play a critical part in ensuring the accuracy and fairness of decisions while maintaining compliance with industry regulations.
🧾 Key Responsibilities:
- Analyze and resolve appeals and grievances in a timely manner
- Review documentation, contracts, and medical records related to claim denials
- Interpret healthcare plan coverage, coding policies, and medical necessity standards
- Communicate with providers, members, and internal departments for clarification or additional information
- Document appeal outcomes and maintain accurate records in case management systems
- Comply with HIPAA, CMS, NCQA, and state/federal regulatory standards
✅ Qualifications:
- High school diploma or GED required; Associate’s or Bachelor’s degree preferred
- 1–3 years of experience in claims processing, billing, medical coding, or appeals
- Familiarity with ICD-10, CPT codes, and healthcare terminology
- Strong analytical and written communication skills
- Ability to handle confidential information and multitask under deadlines
- Experience with claims software and Microsoft Office Suite
🎁 Benefits:
- Competitive pay and performance incentives
- Remote work flexibility
- Health, dental, and vision insurance
- 401(k) with company match
- Career development and training opportunities
📩 How to Apply:
Please send your resume and cover letter to: [email@example.com]
Subject: Appeals Rep Application – [Your Name]