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Insurance Appeals Jobs in Colorado (NOW HIRING)

Dane Street

Orthopedics Physician

Bayfield, CO · On-site

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer ...

Dane Street

Orthopedics Physician

Bayfield, CO · On-site

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer ...

S. A. Miro, Inc.

BIM Specialist II

Denver, CO · On-site

Health, Dental, Vision, Life, and Pet Insurance * Professional Development Assistance * Referral Program * Relocation Assistance * Hybrid Work Environment Additional Perks: * In-Office Snack and ...

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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 Colorado?

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

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

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

What cities in Colorado are hiring for Insurance Appeals jobs?

Cities in Colorado with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Colorado as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 19% Part Time, 1% Temporary, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Orthopedics Physician

Dane Street

Bayfield, CO • On-site

Full-time

Re-posted 2 days ago

Job description

As Physician Reviewer/Advisor for Independent Medical Exams (IME), you will utilize clinical expertise and reviews insurance appeals, and prospective and retrospective claims. The Physician Reviewer will provide an interpretation of the medical necessity of services provided by other healthcare professionals in compliance with client specific policies, nationally recognized evidence-based guidelines, and standards of care.

MAJOR DUTIES AND RESPONSIBILITIES:

    • Reviews all medical records and addresses each question posed by the client utilizing client specific criteria or other nationally recognized evidence-based criteria
    • Ensures that the rationale for the determination is clear, concise, and contains adequate supporting documentation to substantiate the decision
    • Identifies, critiques, and utilizes current criteria and resources such as national, state, and professional association guidelines and peer-reviewed literature that support sound and objective decision-making and rationales in reviews; refrains from using case studies, cohorts, and the like to make decisions due to their limited sample sizes
    • Provides copies of any criteria utilized in a review with the report in a timely manner
    • Returns cases on or before the due date and time
    • Makes telephone calls as mandated by the state and/or client specifics
    • Maintains proper credentialing and state licenses and any special certifications or requirements necessary to perform the job
    • Attends all required orientation and training
    • Performs other duties as assigned including identifying and responding to quality assurance issues, complaints, regulatory issues, depositions, court appearances, or audits
    • Board certification required, active practice required

PLEASE BE AWARE: In the interest of the security of all parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason including the purchase of equipment.

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