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Appeals Representative Jobs (NOW HIRING)

Humana

Appeals Rep

Olympia, WA · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

PFS Group

Insurance Appeals Rep

Houston, TX · On-site

The Appeals Representative will be responsible for reviewing basic clinical documentation and relevant payer guidelines to draft timely and effective appeals. They will be measured on appeals success ...

Humana

Appeals Rep

Sacramento, CA · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Pierre, SD · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Hartford, CT · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Baton Rouge, LA · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

PFS Group

Insurance Appeals Rep

Houston, TX

The Appeals Representative will be responsible for reviewing basic clinical documentation and relevant payer guidelines to draft timely and effective appeals. They will be measured on appeals success ...

Humana

Appeals Rep

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana, Inc.

Appeals Rep

Nashville, TN · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Annapolis, MD · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Cheyenne, WY · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Salt Lake City, UT · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Denver, CO · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Atlanta, GA · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Little Rock, AR · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Columbia, SC · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Trenton, NJ · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Carson City, NV · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

Humana

Appeals Rep

Frankfort, KY · On-site

$48K - $65K/yr

As the Appeals Representative 4 you will * Managed Level 1 appeal cases, ensuring accuracy, completeness, and compliance with CMS requirements. * Reviewed clinical documentation to support appeal ...

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Appeals Representative information

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$12

$24

$50

How much do appeals representative jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for appeals representative in the United States is $24.55, according to ZipRecruiter salary data. Most workers in this role earn between $14.90 and $28.85 per hour, depending on experience, location, and employer.

What does an appeals representative do?

Appeals representatives review and process medical policies, grievances, and denials of medical claims. As an appeals representative, your duties are to review each complaint and denial, contact customers to gather details of their case, document the process as it moves through the system, provide a report regarding case statistics, and prepare for appeal hearings. You are also responsible for analyzing the policy connected with a claim to determine company liability. All cases need documentation for final case determination.

What skills do you need to be an appeals representative?

An appeals representative needs strong communication and interpersonal skills to explain decisions clearly and handle sensitive situations. Attention to detail, problem-solving abilities, and knowledge of relevant policies or regulations are essential, along with proficiency in computer systems and documentation tools.

What are the key skills and qualifications needed to thrive as an appeals representative, and why are they important?

To thrive as an Appeals Representative, you need a solid understanding of insurance policies, claims processing, and healthcare regulations, often supported by a relevant associate or bachelor’s degree. Familiarity with claims management software, medical coding systems like ICD-10, and proficiency in Microsoft Office are typically required. Strong attention to detail, analytical thinking, and effective written and verbal communication skills help distinguish top performers in this role. These competencies ensure accurate resolution of appeals, compliance with regulations, and effective advocacy for clients or patients.

What is the difference between Appeals Representative vs Claims Processor?

CriteriaAppeals RepresentativeClaims Processor
Required CredentialsHigh school diploma or equivalent; sometimes certifications in insurance or healthcareHigh school diploma or equivalent; often familiarity with insurance policies
Work EnvironmentOffice setting, handling customer or provider appealsOffice setting, reviewing and processing insurance claims
Employer & Industry UsageInsurance companies, healthcare providers, government agenciesInsurance companies, healthcare organizations, third-party administrators
Common Search & Comparison IntentUnderstanding roles related to appeals and dispute resolutionUnderstanding claims processing and related job functions

Appeals Representatives focus on reviewing and resolving disputes related to denied claims, often requiring knowledge of insurance policies and customer service skills. Claims Processors primarily handle the initial review and processing of insurance claims, ensuring accuracy and completeness. While both roles work within the insurance and healthcare industries, Appeals Representatives specialize in appeals and dispute resolution, whereas Claims Processors focus on claim intake and processing.

How does an appeals representative typically collaborate with other departments during the appeals process?

As an Appeals Representative, you'll often work closely with teams such as claims processing, medical review, and customer service to gather necessary documentation and clarify case details. Collaboration is essential for ensuring appeals are evaluated accurately and efficiently, as you may need to request additional information, verify policy interpretations, or communicate with healthcare providers. This cross-departmental teamwork helps resolve member concerns and supports compliance with regulatory guidelines, making strong communication and organizational skills especially valuable in this role.
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Appeals Representative jobs near you
Infographic showing various Appeals Representative job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $51,068 per year, or $24.6 per hour.

Appeals Representative I

Federal Hearings And Appeals

Wilkes Barre, PA • On-site

$40K - $45K/yr

Full-time

Re-posted 28 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