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Appeals Processor Jobs (NOW HIRING)

CERiS

Appeals Representative II

Fort Worth, TX · Remote

$20.08 - $30.06/hr

Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents * Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy ...

CERiS

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents * Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy ...

Quadax, Inc.

Appeals Specialist

Cleveland, OH

$19 - $21/hr

Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP's. * Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or ...

Quadax

Appeals Specialist

Middleburg Heights, OH · On-site

$19 - $21/hr

Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP's. * Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or ...

Corvel

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents * Ensure compliance with HIPAA, CMS guidelines, and client instructions and policy ...

VIVA Health

Provider Appeals Coordinator

Birmingham, AL

$20.75 - $25.50/hr

This position is responsible for documenting the end-results of the appeals process. Key Responsibilities * Review written appeals upon receipt. Forward non-par Medicare appeals to the Medicare ...

Viva Health

Provider Appeals Coordinator

Birmingham, AL · On-site

$20.75 - $25.50/hr

This position is responsible for documenting the end-results of the appeals process. Key Responsibilities * Review written appeals upon receipt. Forward non-par Medicare appeals to the Medicare ...

UHS

APPEALS SPECIALIST

Las Vegas, NV · On-site

$22.16 - $29.36/hr

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

Globus Medical

Appeals Specialist

Collegeville, PA · On-site

... appeals process . Essential Functions: * Partner with internal partners, to secure HFX Access and drive effective pull-through with payers * Meet metrics and timeliness standards to achieve ...

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Appeals Processor information

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How much do appeals processor jobs pay per hour?

As of Aug 6, 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 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 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.

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 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.

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 strong attention to detail, communication skills, and the ability to handle sensitive information under pressure.
More about Appeals Processor jobs
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 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 81% Physical, 6% Hybrid, and 13% Remote job distribution, with an average salary of $37,422 per year, or $18 per hour.

Nurse Specialist - Clinical Denials and Appeals

Huron Consulting Group

Chicago, IL • On-site, Remote

Full-time

Medical, Dental, Vision

Re-posted 6 days ago

Huron Consulting Group rating

7.2

Company rating: 7.2 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

54th of 72 rated business consultants

Job description

Huron helps its clients drive growth, enhance performance and sustain leadership in the markets they serve. We help healthcare organizations build innovation capabilities and accelerate key growth initiatives, enabling organizations to own the future, instead of being disrupted by it. Together, we empower clients to create sustainable growth, optimize internal processes and deliver better consumer outcomes.
Health systems, hospitals and medical clinics are under immense pressure to improve clinical outcomes and reduce the cost of providing patient care. Investing in new partnerships, clinical services and technology is not enough to create meaningful and substantive change. To succeed long-term, healthcare organizations must empower leaders, clinicians, employees, affiliates and communities to build cultures that foster innovation to achieve the best outcomes for patients.
Joining the Huron team means you'll help our clients evolve and adapt to the rapidly changing healthcare environment and optimize existing business operations, improve clinical outcomes, create a more consumer-centric healthcare experience, and drive physician, patient and employee engagement across the enterprise.
Join our team as the expert you are now and create your future.
The Clinical Denials and Appeals Nurse Specialist (IP & OP) is responsible for reviewing the claims denied and carrying out the appeals process appropriately and in a timely manner. This individual identifies and works denials, responding to the denial reason and resubmitting any information needed to the payor The Clinical Denials and Appeals Specialist should be knowledgeable of U.S. state/federal laws that relate to payor contracts and to the appeals process. This role requires frequent and effective communication via phone, email, and instant messaging with the various engagement teams. Strong oral and written communication skills, analytical skills, ability to work independently, and be self-motivated are required.
KEY RESPONSIBILITES:
Denials and Appeals Management
  • Work denials and appeals timely, evaluating the denial reason including information from the payor and payor policies, reviewing the clinical documentation, assessing options and completing next steps
  • Submit retro-authorizations in accordance with payor requirements in response to authorization denials
  • Conducts medical necessity reviews, based on denial root cause, and prepares any required clinical documentation summaries to accompany appeals.
  • Write and submit written appeals which include compelling arguments based on clinical documentation, third-party payer medical policies, and contract language. Appeals are submitted timely and tracked through final outcome.
  • Document all actions taken and follow-up timely as needed related to resolving denials and appeals with third-party payers in a timely manner
  • Tracks the status and progress of denials and appeals
  • Completes relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
  • Executes internal and external correspondence accurately, clearly, concisely, and professionally while following organizational regulations
  • Effectively handles all communications, including telephone, electronic, and paper correspondence from payers and departments within the business office

Tracking, Reporting, and Trends
  • Maintains data on the types of claims denied and root causes of denials
  • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
  • Collaborate with management to recommend process changes to address root cause of denials and overall improvement to reduce A/R
  • Prepares, maintains, assists with, and submits reports as required

Compliance and Continuous Improvement
  • Collaborate with team members to continually improve services, and engage in process and quality improvement activities
  • Identify system improvement opportunities and contribute to the testing of system modifications
  • Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
  • Complies with state and federal regulations, accreditation/compliance requirements, and Huron's policies, including those regarding fraud and abuse, confidentiality, and HIPAA
  • Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliances issues and payer discrepancies
  • Participates in ongoing professional development to enhance job knowledge and performance
  • Reports all identified compliance risks to appropriate leadership

Other duties and responsibilities as assigned.
QUALIFICATIONS:
Required Qualifications:
  • Clinical Appeals Experience: At least 1 year of clinical appeal writing experience.
  • Clinical Experience: Minimum of 3-5 years acute care clinical experience in a hospital setting (Med/Surg, or similar preferred); 2-3 years if ICU experience.
  • Education: Associate Degree in Nursing (ADN) or Diploma in Nursing.
  • Licensure: Must be Registered Nurse with an active USRN license.
  • RCM Knowledge: Proficiency in using InterQual or MCG clinical guidelines. Broad Knowledge of U.S. Government Programs and Insurance Regulations
  • Software Knowledge: Proficiency with hospital-based electronic medical records (EMR) such as Epic, Cerner, or Meditech.

Preferred Qualifications:
  • Education: Bachelor of Science in Nursing (BSN) preferred
  • Credential/Certification: Case management or clinical appeals or clinical denials certification (ACMA) is preferred.
  • Software Knowledge: Proficiency with using computer programs for tracking denials and appeals. Proficiency with Microsoft office suite (Excel, Word, PowerPoint, Outlook, SharePoint)
  • Soft Skills:
  • Ability to pay close attention to details; strong follow-up and follow-through skills
  • Regularly makes complex decisions within the scope of the position, and is comfortable working independently
  • Requires the use of independent judgment, discretion and decision-making abilities
  • Demonstrates teamwork and integrity in all work-related activities
  • Ability to interact with internal and external customers in a professional manner
  • Strong analytical and critical thinking skills.
  • Experience in a matrixed environment
  • Excellent written and verbal communication skills

The estimated hourly range for this job is $33.65 - $43.27. The range represents a good faith estimate of the range that Huron reasonably expects to pay for this job at the time of the job posting. The actual salary paid to an individual will vary based on multiple factors, including but not limited to specific skills or certifications, years of experience, market changes, and required travel. The job is also eligible to participate in Huron's benefit plans which include medical, dental and vision coverage and other wellness programs. The salary range information provided is in accordance with applicable state and local laws regarding salary transparency that are currently in effect and may be implemented in the future.
Position Level
Analyst
Country
United States of America

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About Huron Consulting Group

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Huron Consulting Group, based in Chicago, IL, US, is a leading global management consulting firm specialized in providing performance improvement and reformation skills to different types of organizations. The company operates in the management consulting industry, which includes strategy, operations, technology, and analytics. Founded in 2002, Huron Consulting Group aids entities to tackle complex business challenges, enhance their ability to drive change, encourage their efficiency, and stimulate innovation. The company's overriding mission is to assist clients in becoming more successful.

Industry

Business management consulting

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

Year founded

2002

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