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Appeals Representative Jobs (NOW HIRING)

CERiS

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory ...

Humana, Inc.

Grievances & Appeals Representative

Rico, CO · On-site +1

$34K - $45K/yr

Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to ...

Humana

Grievances & Appeals Representative

$34K - $45K/yr

Become a part of our caring community The Grievances & Appeals Representative 3 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to ...

Covenant Health

INSURANCE APPEALS ASSOC

Knoxville, TN · On-site

Provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations. Responsibilities * Analyze denials and coordinates insurance appeals.

Covenant Health

INSURANCE APPEALS ASSOC

Knoxville, TN · On-site

Provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations. * Analyze denials and coordinates insurance appeals. * Recognizes ...

Brownhealth

Denials Appeal Representative

Pawtucket, RI · On-site

$20.96 - $34.61/hr

The Denials Appeal Representative prepares monthly denial reports for the Director of Finance and collaborates with EPIC billing and operational teams to determine whether system build adjustments or ...

MedReview

Appeals Specialist

Manhattan, NY · On-site +1

$50K/yr

The Appeals Specialist I is responsible for performing triage, review, analysis, and resolution of ... Responsibilities This list does not represent all responsibilities for this position. Candidate ...

Globus Medical

Appeals Specialist

Collegeville, PA · On-site

Represents the company in a professional manner and uphold the highest standards of ethical ... Prior patient appeals experience is preferred * Prior experience with Medicare, Medicaid, TRICARE ...

Globusmedical

Appeals Specialist

Collegeville, PA

Represents the company in a professional manner and uphold the highest standards of ethical ... Prior patient appeals experience is preferred * Prior experience with Medicare, Medicaid, TRICARE ...

MedReview

Appeals Specialist

Manhattan, NY · Remote

The Appeals Specialist I is responsible for performing triage, review, analysis, and resolution of ... Responsibilities This list does not represent all responsibilities for this position. Candidate ...

Independence Blue Cross

Clinical Appeals Coord

$22.50 - $28/hr

... representative statements. • Apply clinical nursing knowledge, utilization management principles, benefit language, medical policy, and evidence-based criteria to support appropriate case ...

WVU Medicine

Clinical Appeals Coordinator

$22.50 - $28/hr

The Appeals Nurse will investigate and process medical necessity requests from both members and ... The physical demands described here are representative of those that must be met by an employee to ...

Peak Health

Clinical Appeals Coordinator

$22.50 - $28/hr

The Appeals Nurse will investigate and process medical necessity requests from both members and ... The physical demands described here are representative of those that must be met by an employee to ...

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Appeals Representative information

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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 II

CorVel Healthcare Corporation

Fort Worth, TX • Remote

$20.08 - $30.06/hr

Full-time

Re-posted 20 days ago

Job description

The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, and industry standards, along with CMS and state guidelines. This role ensures that all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Receiving and analyzing appeal documentation to determine appropriate actions
  • 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 standards
  • Utilize applicable tools and resources to complete setup
  • Additional duties as assigned

KNOWLEDGE & SKILLS:

  • Knowledge of Medicare, Medicaid, and commercial insurance guidelines
  • Strong attention to detail, time management, and organizational skills
  • Excellent written and verbal communication skills
  • Knowledge of medical terminology and CPT/ICD codes
  • Proficiency with Microsoft applications

EDUCATION & EXPERIENCE:

  • High school diploma or equivalent
  • 1+ years of experience in healthcare, insurance, claim processing, or customer service
  • 1+ years working with customers in a fast-paced, deadline-oriented environment
  • 1+ years of experience as an Appeals Representative
  • Strong technical skills with the ability to work across multiple software systems and work remotely with self-management skills

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $20.08 - $30.06 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CERIS:

CERIS, a division of CorVel Corporation, a certified Great Place to Work® Company, offers incremental value, experience, and a sincere dedication to our valued partners. Through our clinical expertise and cost containment solutions, we are committed to accuracy and transparency in healthcare payments. We are a stable and growing company with a strong, supportive culture along with plenty of career advancement opportunities. We embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy,

Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401 K, ROTH 401 K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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