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Insurance Appeals Jobs in California (NOW HIRING)

Charter Healthcare

Appeals Assistant

Rancho Cucamonga, CA · On-site

$20 - $30/hr

The Appeals Assistant: Responsible for ensuring professional handling of all provider appeals in a ... Valid driverâ€'s license and auto insurance. FUNCTIONS AND RESPONSIBILITIES: 1. Under the ...

LIBERTY DENTAL

$23 - $28.50/hr

Minimum 5 years of experience in health insurance, preferably within dental insurance. * Minimum 3 years of experience in grievance and appeals, healthcare law, dental law, or a related regulatory ...

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Insurance Appeals information

What are insurance appeals?

Insurance appeals are formal requests made to an insurance company to reconsider and potentially overturn a denied claim or coverage decision. When an insurance provider refuses to pay for a service or treatment, policyholders or healthcare providers can submit an appeal with supporting documentation to argue why the claim should be approved. The appeals process typically involves several steps and may require detailed medical records, letters from healthcare professionals, and a clear explanation of why the original decision should be reversed.

What are the key skills and qualifications needed to thrive in insurance appeals?

To thrive in Insurance Appeals, you need a solid understanding of insurance policies, claims processes, medical terminology, and relevant regulations, often supported by experience in healthcare administration or a related field. Familiarity with claims management software, electronic health records (EHRs), and knowledge of HIPAA compliance are typically required. Strong analytical skills, attention to detail, and effective written and verbal communication set outstanding professionals apart. These skills are crucial for efficiently navigating complex appeals, ensuring compliance, and achieving positive outcomes for clients or organizations.

What are some common challenges faced in an insurance appeals role, and how can they be managed?

Professionals in Insurance Appeals often encounter challenges such as navigating complex policy guidelines, handling tight deadlines, and managing extensive documentation requirements. Staying organized and up-to-date on insurance regulations is essential to ensure accurate and timely submissions. Collaborating closely with medical providers, patients, and insurance representatives can help clarify information and strengthen appeal cases. Effective time management and clear communication are key to overcoming these challenges and achieving successful outcomes.

What are popular job titles related to Insurance Appeals jobs in California?

For Insurance Appeals jobs in California, the most frequently searched job titles are:

What job categories do people searching Insurance Appeals jobs in California look for?

The top searched job categories for Insurance Appeals jobs in California are:

What cities in California are hiring for Insurance Appeals jobs?

Cities in California with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in California as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 90% In-person, and 10% Hybrid job distribution.

Appeals Specialist

Cross America Financial, LLC

Gardena, CA • On-site

Full-time

Medical, Retirement, PTO

Re-posted yesterday

Job description

APPEALS SPECIALIST 


Do you like challenging payers?  That feeling of satisfaction when your appeal is overturned?   Then, this position may be right for you!   


CAF is in search of an experienced Appeals Specialist who is well versed in challenging insurance denials, utilizing payer guidelines and applicable state laws.  The ideal candidate must have the ability to multitask, meet goals and work well individually and with others on special projects and individual workloads.     


RESPONSIBILITIES: 

  • Developing well-supported appeal arguments, where an appeal is warranted.
  • Work with and contact insurance companies to resubmit denied/underpaid claims that are inaccurately processed and continually upheld. 
  • Notate system of record thoroughly and accurately. 
  • Filing complaints and grievances through the DMHC, DOI, DOL, CMS and Medicaid systems to resolve unfair payment practices and trends.   
  • Filing complaints to the jurisdiction of HMO, PPO, ERISA, Medicare and Medicaid agencies when claims are denied in error.  
  • Perform follow up on any outstanding claims, manage correspondence and requests and research denials and zero payments. 


MINIMUM REQUIREMENTS/QUALIFICATIONS: 

  • 3 to 5+ years of recent experience writing insurance appeals and pursuing payers for collection on behalf of hospitals (facility charges). 
  • Understanding of medical terminology, bill review, general coding, and appeals resolution. 
  • Ability to read, analyze, and interpret hospital medical bills, records, statutes, contracts, and other relevant documents. 
  • Knowledge of medical necessity, time filing, UCR and contract denials. 
  • High comfort level with Excel 
  • A focused, organized, and detail-oriented approach to work. 
  • 50+ wpm 
  • Knowledge of Milliman/InterQual guidelines 
  • Excellent oral and written communication skills. 
  • Ability to pass a thorough background check and drug screen.  
  • Ability to perform critical work under deadlines.  
  • Ability to work in a changing environment and handle multiple tasks 


PREFERRED (NOT REQUIRED): 

  • Compiling appeals and collecting for hospital/facility component with general knowledge of insurance follow-up 
  • Experience with billing and collection systems such as CUBS, Meditech, Cerner etc. 


ABOUT CAF:  

CAF is a fast-growing revenue cycle agency exclusively serving hospitals, and conveniently located at the intersection of the 405 and 110 freeways. We utilize amazing customer service to help hospitals bill, service and collect more of the money they are due, so they may continue to provide critical healthcare services to their patients. Our team members strive to be better every single day, to do quality work, and to make a lasting impact on their lives and the lives of others.  

  

COMPENSATION & BENEFITS  

Full-time position.  Pay commensurate with experience. Paid training.  Generous paid vacation, holidays, 401k, Aflac supplemental insurance (at employee expense), and monthly bonus opportunities for those who qualify. No company paid medical benefits at this time. Plenty of growth opportunities for friendly, focused, results-driven people.