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Appeals Jobs (NOW HIRING)

LHH US

Appeals Coordinator

Tempe, AZ · On-site

$53K - $65K/yr

Appeals Coordinator (Healthcare Revenue Cycle) This role plays a critical part in maximizing reimbursement and protecting revenue through expert-level appeals and payer negotiations. What You'll Do

Commonwealth of Pennsylvania

Appeals Referee

Harrisburg, PA · Hybrid

$77.38K - $117.50K/yr

As an Appeals Referee, you will perform the following duties: Hearing Management: Conduct hearings by applying rules of evidence and guiding parties through the process Evidence Evaluation: Analyze ...

UHS

Appeals Specialist

Richmond, VA · On-site

The Appeals Specialist is responsible for the resolution of all appeals relating to technical issues identified during the billing of claims and the follow-up on the clinical appeals performed by the ...

LHH US

Appeals Coordinator

Tempe, AZ

$53K - $65K/yr

Appeals Coordinator (Healthcare Revenue Cycle) This role plays a critical part in maximizing reimbursement and protecting revenue through expert-level appeals and payer negotiations. What You'll Do

SERVICES ON-SITE

Appeals Coordinator

Miami, FL

$21 - $26/hr

We are seeking an experienced Appeals Coordinator with at least 2 years of relevant experience to join one of our largest clients, a prestigious law firm based in Miami, Florida. This role is ideal ...

Advanced Pain Care

Appeals Specialist Team Lead

Austin, TX · On-site

$24 - $27/hr

The Appeals Lead plays a critical role in driving improved reimbursement outcomes, reducing preventable denials, and promoting accountability through KPI monitoring and staff development. Duties and ...

UHS

Appeals Specialist

Richmond, VA · On-site

The Appeals Specialist is responsible for the resolution of all appeals relating to technical issues identified during the billing of claims and the follow-up on the clinical appeals performed by the ...

Beaufort County, SC

Appeals BAA Specialist

Beaufort, SC · On-site

$20.37 - $24.44/hr

Creates appeal files, enters property values from settled appeals, prepares and processes documentation relating to real property appeals, and enters value overrides for property appeals. * Posts ...

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Appeals information

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$30.5K

$86.5K

$115.5K

How much do appeals jobs pay per year?

As of May 31, 2026, the average yearly pay for appeals in the United States is $86,480.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,500.00 and $98,500.00 per year, depending on experience, location, and employer.

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

To thrive as an Appeals Specialist, you need a solid understanding of insurance claims processes, healthcare regulations, and strong analytical skills, usually supported by a relevant degree or experience in medical billing or coding. Familiarity with claims management software, electronic health record (EHR) systems, and knowledge of payer-specific guidelines are essential. Attention to detail, persistence, and effective written and verbal communication skills help resolve complex cases and advocate for patients or organizations. These skills ensure timely and accurate resolution of denied claims, maximizing reimbursements and maintaining compliance with industry standards.

What are the main challenges faced by professionals working in appeals, and how can they best navigate them?

Appeals professionals often encounter complex regulations, tight deadlines, and emotionally charged interactions with clients or stakeholders. Navigating these challenges requires strong organizational skills, attention to detail, and the ability to interpret legal or policy documents accurately. Effective communication and collaboration with legal teams, case managers, or external agencies are also essential for building persuasive cases. Staying updated on relevant laws and procedural changes can help appeals specialists advocate successfully and reduce the risk of errors.

What are 'Appeals' jobs?

Appeals jobs involve handling requests to review and potentially overturn previous decisions, often in legal, insurance, healthcare, or government settings. Professionals in this field review cases, gather and analyze evidence, and ensure that appeals processes follow established policies and regulations. They may interact with clients, legal representatives, or regulatory bodies to resolve disputes or clarify decisions. Appeals specialists play a crucial role in ensuring fairness and compliance within their organizations.

What is the difference between Appeals vs Dispute Resolution Specialist?

AspectAppealsDispute Resolution Specialist
CredentialsTypically requires knowledge of appeals processes, legal or administrative certificationsRequires certifications in conflict resolution, negotiation, or mediation
Work EnvironmentOften in government agencies, healthcare, or insurance sectorsCommonly in legal firms, corporate settings, or mediation centers
Employer & IndustryPublic sector, healthcare, insuranceLegal, corporate, consulting
Search & Comparison IntentUnderstanding appeals procedures, filing appealsResolving disputes, mediating conflicts

While both roles involve conflict resolution, Appeals specialists focus on managing formal appeal processes within organizations or agencies, whereas Dispute Resolution Specialists handle broader conflict mediation and negotiation. The roles overlap in conflict management but differ in scope and setting.

More about Appeals jobs
What cities are hiring for Appeals jobs? Cities with the most Appeals job openings:
What are the most commonly searched types of Appeals jobs? The most popular types of Appeals jobs are:
What states have the most Appeals jobs? States with the most job openings for Appeals jobs include:
Appeals jobs near you

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 12 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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