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Appeals Processor Jobs (NOW HIRING)

CR Fletcher

Appeals Specialist

Syracuse, NY · On-site

Prepare, review, and process appeal documents in accordance with court rules and deadlines. * Monitor appeal timelines and maintain an accurate calendar of filing deadlines. * Coordinate with ...

Independence Blue Cross

Supervisor Appeals

Philadelphia, PA · On-site

$22.25 - $27.50/hr

This role ensures timely, accurate, and compliant processing of member and provider administrative appeals in accordance with NCQA standards, contractual obligations, and organizational policies. The ...

Careers Integrated Resources Inc

Admin2-Appeals

This role involves handling various administrative tasks related to case management and appeals, ensuring efficient and accurate processing of information. Responsibilities: * Type/generate letters ...

Integrated Resources

Admin2-Appeals

This role involves handling various administrative tasks related to case management and appeals, ensuring efficient and accurate processing of information. Responsibilities: * Type/generate letters ...

Axelon

Appeals Nurse

Review and process Iowa Medicaid Member Appeals * Manage the entire appeal process from start to finish * Conduct outreach to members/providers * Complete clinical reviews and send cases to specialty ...

MedImpact

Appeals Clinical Specialist

San Diego, CA · On-site

$73.30 - $94.43/hr

Summary The Appeals team oversees all operational and clinical aspects of the appeals process, including intake, case processing, clinical determinations, notifications, and compliance with ...

MedImpact

Appeals Clinical Specialist

San Diego, CA · On-site

$73.30 - $94.43/hr

Summary The Appeals team oversees all operational and clinical aspects of the appeals process, including intake, case processing, clinical determinations, notifications, and compliance with ...

MedImpact

Appeals Clinical Specialist

San Diego, CA · On-site +1

$73.30 - $94.43/hr

Summary The Appeals team oversees all operational and clinical aspects of the appeals process, including intake, case processing, clinical determinations, notifications, and compliance with ...

Independence Blue Cross

Clinical Appeals Coord

$22.50 - $28/hr

Position Summary The Clinical Appeals Coordinator, RN is responsible for supporting the end-to-end processing of clinical appeals, including medical necessity, benefit, pharmacy, behavioral health ...

Medimpact

Appeals Clinical Specialist

San Diego, CA · On-site

$71.64 - $129.49/hr

Summary**The Appeals team oversees all operational and clinical aspects of the appeals process, including intake, case processing, clinical determinations, notifications, and compliance with ...

tnhealth

Grievances and Appeals Coordinator

Franklin, TN · On-site

$21.75 - $27/hr

The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity and administrative denials and appeals for Medicare Advantage members in accordance with Medicare ...

UHS

APPEALS SPECIALIST

Las Vegas, NV · On-site

Leverage experience with hospital acute care payer contracts to support claim resolution and appeals processes. This opportunity offers the following: * Challenging and rewarding work environment

tnhealth

Grievances and Appeals Coordinator

Franklin, TN · On-site

$21.75 - $27/hr

The Grievances and Appeals Coordinator processes, tracks and follows up on all medical necessity and administrative denials and appeals for Medicare Advantage members in accordance with Medicare ...

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Appeals Processor information

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How much do appeals processor jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for appeals processor in the United States is $17.99, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $19.71 per hour, depending on experience, location, and employer.

What does an appeals processor do?

An Appeals Processor is responsible for reviewing, analyzing, and making determinations on appeals submitted by clients or claimants, often in the context of insurance, healthcare, or government benefits. They examine supporting documentation, apply relevant policies and regulations, and communicate decisions to all parties involved. Appeals Processors ensure that all appeals are handled fairly, accurately, and within specified timeframes, often acting as a liaison between claimants and organizations.

What are the key skills and qualifications needed to thrive as an appeals processor?

To thrive as an Appeals Processor, you need strong analytical abilities, attention to detail, and familiarity with insurance or healthcare claims processes, often supported by relevant experience or a background in healthcare administration. Proficiency with claims management software, electronic health record (EHR) systems, and knowledge of regulatory guidelines such as HIPAA are typically required. Excellent communication, problem-solving skills, and the ability to manage time effectively help you interact with claimants and work efficiently under deadlines. These skills ensure accurate, timely processing of appeals and compliance with industry standards, directly impacting customer satisfaction and organizational success.

What are some common challenges faced by appeals processors, and how can they be effectively managed?

Appeals Processors often encounter challenges such as handling high volumes of complex cases, interpreting regulatory guidelines, and meeting strict deadlines. To manage these effectively, it's important to develop strong organizational skills, stay updated on policy changes, and maintain clear communication with other departments like claims and customer service. Many successful Appeals Processors also rely on checklists and workflow tools to ensure accuracy and efficiency, especially when reviewing sensitive or time-critical appeals.

What is the difference between Appeals Processor vs Claims Adjuster?

AspectAppeals ProcessorClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licensesHigh school diploma or equivalent; insurance licenses often preferred
Work EnvironmentOffice setting, handling appeals cases and documentationOffice or field setting, investigating and evaluating insurance claims
Industry UsageUsed mainly in insurance companies, government agenciesCommon in insurance companies, healthcare, and auto industries
Search & Comparison IntentPeople comparing roles related to insurance appeals and processingPeople comparing roles involving claim evaluation and adjustment

Appeals Processors focus on reviewing and processing appeals related to denied claims, ensuring compliance and accuracy. Claims Adjusters evaluate insurance claims, investigate damages, and determine payouts. While both roles work within the insurance industry and require similar credentials, Appeals Processors handle appeals cases specifically, whereas Claims Adjusters handle the initial claim assessment and settlement process.

Is claims processing a stressful job?

Claims processing as an appeals processor can be stressful due to tight deadlines, high workload, and the need for accuracy in evaluating complex cases. The role often requires attention to detail, strong organizational skills, and the ability to handle sensitive information, which can contribute to job-related stress.
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What job categories do people searching Appeals Processor jobs look for?

The top searched job categories for Appeals Processor jobs are:

Appeals Processor jobs near you
Infographic showing various Appeals Processor job openings in the United States as of August 2026, with employment types broken down into 92% Full Time, 6% Part Time, and 2% Contract. Highlights an 78% Physical, 7% Hybrid, and 15% Remote job distribution, with an average salary of $37,422 per year, or $18 per hour.

Appeals Representative I

Federal Hearings And Appeals

Wilkes Barre, PA • On-site

Full-time

Re-posted 12 days ago

Job description


Applicant must be available for training for 4-6 weeks of training after hire. 


About the Role:

The Appeals Representative I plays a critical role in the healthcare and social assistance industry by managing and resolving appeals related to healthcare claims and services. This position is responsible for thoroughly reviewing appeal requests, gathering necessary documentation, and communicating effectively with patients, providers, and internal teams to ensure fair and timely resolution. The role requires a strong understanding of healthcare policies, insurance regulations, and patient rights to accurately assess each case. The Appeals Representative I contributes to maintaining compliance with regulatory standards while striving to deliver exceptional customer service. Ultimately, this position supports the organization's mission to provide equitable healthcare access and resolve disputes efficiently.

Minimum Qualifications:

  • High school diploma or equivalent required; Associate’s degree or higher preferred.
  • Basic knowledge of healthcare terminology, insurance processes, and regulatory requirements.
  • Strong written and verbal communication skills.
  • Proficiency with computer systems and case management software.
  • Ability to handle sensitive information with confidentiality and professionalism.

Preferred Qualifications:

  • Experience working in healthcare claims, appeals, or customer service roles.
  • Familiarity with HIPAA regulations and healthcare compliance standards.
  • Training or certification in medical billing, coding, or healthcare administration.
  • Demonstrated problem-solving skills and ability to manage multiple cases simultaneously.
  • Experience working with diverse populations and maintaining cultural sensitivity.

Responsibilities:

  • Review and analyze appeal requests submitted by patients, providers, or other stakeholders to determine eligibility and validity.
  • Gather and evaluate relevant medical records, billing information, and policy documents to support the appeals process.
  • Communicate clearly and professionally with appellants, healthcare providers, and internal departments to clarify information and provide updates on appeal status.
  • Document all appeal activities accurately in the case management system to ensure transparency and compliance.
  • Collaborate with clinical and legal teams as needed to facilitate complex case reviews and ensure adherence to healthcare regulations.
  • Maintain up-to-date knowledge of healthcare laws, insurance policies, and organizational procedures related to appeals.
  • Meet established performance metrics related to appeal resolution timelines and quality standards.

Skills:

The Appeals Representative I utilizes strong analytical skills daily to review and interpret complex healthcare documentation and insurance policies. Effective communication skills are essential for interacting with patients, providers, and internal teams to clarify appeal details and provide status updates. Attention to detail ensures accurate documentation and compliance with regulatory standards throughout the appeals process. Time management and organizational skills are critical for handling multiple appeals efficiently while meeting deadlines. Additionally, proficiency with case management software and healthcare information systems supports the accurate tracking and resolution of appeals.


on site Monday-Friday
Hours 8am-5pm

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