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Appeal Examiner Jobs (NOW HIRING)

Examination Resources, LLC

$34K - $34K/yr

... appeals, claims processing, and network adequacy, etc. * Complete PBM examination work in the required state software platform. * Interpret state rules and regulations pertaining to enforcement ...

Essc

Claims Examiner 2

Irvine, CA · On-site

$29.33 - $36.54/hr

Monitors and reviews appeals processing of assigned account(s). Provides assistance in special ... The Examiner will audit, conduct root cause analysis, identify issues and propose solutions to ...

City of Cleveland

Commercial Plan Examiner

Cleveland, OH · On-site

$82K - $87K/yr

Description Commercial Plan Examiner Examples of Duties Under the supervision of the Chief Building ... and the Board of Zoning Appeals. Performs other job-related duties as required. Minimum ...

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How much do appeal examiner jobs pay per year?

As of Sep 10, 2026, the average yearly pay for appeal examiner in the United States is $61,362.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,000.00 and $69,500.00 per year, depending on experience, location, and employer.

What are popular job titles related to Appeal Examiner jobs?

For Appeal Examiner jobs, the most frequently searched job titles are:

Infographic showing various Appeal Examiner job openings in the United States as of August 2026, with employment types broken down into 89% Full Time, 9% Part Time, 1% Temporary, and 1% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $61,362 per year, or $29.5 per hour.

Appeals Examiner - West Sacramento, CA

West Sacramento, CA • On-site

Gainwell Technologies
Health Care and Social Assistance • 10K+ employees
Learn more about Gainwell Technologiesexternal

$37K - $53K/yr

Full-time

Medical, Life, Retirement, PTO

Re-posted 20 days ago

Key responsibilities

  • Review provider appeals using approved guidelines and document appeal determinations clearly and concisely.

  • Analyze, research, and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately.

  • Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.

Gainwell Technologies rating

7.9

Company rating: 7.9 out of 10

Based on 84 frontline employees who took The Breakroom Quiz

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
As an Appeals Examiner, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve - a community's most vulnerable.
Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare's biggest challenges.
Your role in our mission
  • Review provider appeals using approved guidelines and documents appeal determinations clearly and concisely.
  • Analyze, research and review appeal documentation to ensure all aspects of the appeal have been addressed properly and accurately while maintaining production goals and quality standards.
  • Resubmit and adjust claims on approved appeals with the proper claim data correction and documentation.
  • Maintain performance within defined quality and quantitative objectives.
  • Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

What we're looking for
  • Total of (2) years or more in medical claims and appeals experience required.
  • Experience working with medical insurance and/or medical terminology required.
  • Highly proficient with exceptional level of accuracy required.
  • Ability to research and verify claim payment issues.
  • Knowledge of Microsoft products (Outlook, Word, Excel and TEAMS)

What you should expect in this role
  • This is an On-site/Office environment at West Sacramento, CA
  • Hours are 6:00 a.m. - 2:30 p.m

Must be a resident of the Greater Sacramento area of California
This posting is intended for pipelining. We will accept applications on an ongoing basis.
#LI-ONSITE
#LI-LS2
#LI-CM1
The pay range for this position is $37,500 - $53,500 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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