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Appeals Representative Jobs (NOW HIRING)

Beaufort County, SC

Appeals BAA Specialist

Beaufort, SC · On-site

$20.37 - $24.44/hr

Examples of Duties The essential functions listed below are those that represent the majority of ... Creates appeal files, enters property values from settled appeals, prepares and processes ...

MedReview

Appeals Specialist II

Manhattan, NY · On-site +1

$50K - $55K/yr

Responsible for all aspects of nonclinical appeals and inquiries Responsibilities This list does not represent all responsibilities for this position. Candidate must understand and be willing and ...

Lumeris, Inc.

Appeals Coordinator

$22.50 - $28/hr

Position: Appeals Coordinator Position Summary: Responsible for reviewing, researching, and ... The physical activities, demands and working conditions represent those an employee encounters ...

State of Maryland

APPEALS CHIEF

Baltimore, MD · On-site

$70K - $110K/yr

Assistance in developing evidence is provided to the veterans so they can be represented in their personal appeals before the Department of Veteran Affairs at the local level or at the Board of ...

MedReview

Appeals Specialist II

Manhattan, NY · Remote

Responsible for all aspects of nonclinical appeals and inquiries Responsibilities This list does not represent all responsibilities for this position. Candidate must understand and be willing and ...

BCForward

Grievance & Appeals Coordinator I

Iowa, IA · Remote

$19.77/hr

Grievance & Appeals Coordinator I Location: Remote (Iowa Residents Only) Duration: 6-Month Contract ... Conduct outbound calls to members and authorized representatives to explain grievance processes and ...

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How much do appeals representative jobs pay per hour?

As of Jun 12, 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 jobs pay $2000 a day?

Some high-paying roles for Appeals Representatives or similar positions in specialized fields can reach $2,000 per day, especially with extensive experience, advanced certifications, or in high-stakes environments like insurance appeals or legal consulting. These roles often require strong negotiation skills, knowledge of regulations, and the ability to handle complex cases efficiently.

What job makes $10,000 a month without a degree?

Appeals Representatives typically do not earn $10,000 a month without a degree; most roles in this field have lower salaries and require strong communication and negotiation skills. High-paying jobs that can reach this level often involve sales, entrepreneurship, or specialized trades, but they usually require experience, certifications, or entrepreneurial effort rather than formal degrees.

What skills do you need to be an appeals specialist?

Appeals specialists need strong communication and analytical skills to review cases and explain decisions clearly. Attention to detail, problem-solving abilities, and knowledge of relevant policies or regulations are essential. Proficiency with computer systems and documentation tools is also important for managing case information efficiently.

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 does an appeals representative do?

An appeals representative reviews and processes appeals related to denied claims, benefits, or decisions. They evaluate documentation, communicate with claimants, and work to resolve disputes accurately and efficiently, often using specialized case management systems.

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.
More about Appeals Representative jobs
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Appeals Representative jobs near you
Infographic showing various Appeals Representative job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 44% In-person, and 56% Remote job distribution, with an average salary of $51,068 per year, or $24.6 per hour.

Appeals Nurse

Blue Cross and Blue Shield of Massachusetts, Inc.

Hingham, MA

$41.72 - $50.99/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 24 days ago

Job description

Ready to help us transform healthcare? Bring your true colors to blue. 

The Role
The Clinical Appeals Nurse Reviewer facilitates, coordinates, and responds to provider appeals for denied services utilizing extensive clinical, regulatory, business, and coding knowledge. Collaborates with the Physician Review Units, Medical & Payment Policy Departments, Provider Service, Member Service and Claims Area to research and resolve provider claims appeals.

The Team
As an integral part of the Clinical Appeals team, the Appeals Nurse Reviewer will serve as a liaison and business expert for claims appeals. This role works collaboratively with Provider Service, Claims, Network Management, Physician Review, and Medical and Payment Policy teams.


Key Responsibilities:

  • Review appeals utilizing sound clinical judgement, medical policy, payment policy guidelines, pricing files, contractual obligations, and billing practices, all to appropriately adjudicate provider and facility claims appeals
  • Use comprehensive knowledge of coding guidelines to approve or reject payment for services provided according to nationally recognized billing processes.
  • Uses comprehensive Nationally known criteria, Medical Policy and Benefits to review appeals.
  • Collaborate with the Physician Review Unit to assist with medical necessity determinations and billing practices.

Key Qualifications:

  • Registered Nurse with certified coding experience and the ability to apply nursing judgement to determine the medical necessity of services provided.
  • The ability to accurately analyze claims submitted for appropriate billing and price claims for payment accurately.
  • The ability to accurately analyze clinical documentation for appropriate decision making.
  • Excellent organizational and prioritization skills with the ability to problem solve independently and in collaboration with teammates, physicians and other associates to appropriately adjudicate appeals.
  • In-depth knowledge of HCPCS, CPT, ICD-10, reject messaging, Modifiers and not otherwise classified (NOC) coding, all to validate billing and services

Education and Experience:

  • Registered Nurse with current Massachusetts licensure required (BSN preferred)
  • Credentialed coder (CPC, CCS) required
  • Minimum 3-5 years acute care experience
Minimum Education Requirements:

High school degree or equivalent required unless otherwise noted above

LocationHinghamTime TypeFull timeHourly Range: $41.72 - $50.99

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

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