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Insurance Appeals Jobs in Ohio (NOW HIRING)

Quadax, Inc.

Appeals Specialist

Cleveland, OH

Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and ...

Quadax, Inc.

Appeals Specialist

Cleveland, OH

$19 - $21/hr

Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and ...

Quadax

Appeals Specialist

Middleburg Heights, OH · On-site

$19 - $21/hr

Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and ...

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Healthcare Appeals and Grievances Coordinator

Columbus, OH · On-site

$23/hr

Appeals & Grievances Coordinator Location: Remote (Must reside in Ohio; candidates located near ... insurance operations, or other roles involving Medicaid, Medicare, or commercial insurance is ...

Saint Therese

Medical Records Coordinator

Avon, OH · On-site

$16 - $20.75/hr

... for insurance appeals and payer reviews. -Conduct chart audits to ensure physician orders, diagnoses, signatures, visits, and other required documentation are completed timely. -Coordinate with ...

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Insurance Appeals information

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 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 popular job titles related to Insurance Appeals jobs in Ohio?

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

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

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

What cities in Ohio are hiring for Insurance Appeals jobs?

Cities in Ohio with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Ohio as of August 2026, with employment types broken down into 86% Full Time, and 14% Part Time. Highlights an 87% In-person, 4% Hybrid, and 9% Remote job distribution.

Appeals Specialist

Quadax, Inc.

Cleveland, OH

Full-time

Re-posted 29 days ago

Quadax rating

7.5

Company rating: 7.5 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

162nd of 244 rated software companies

Job description

Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and required documentation to the state within the filing time limits. Act as a patient advocate by identifying the path needed to obtain the maximum reimbursement under the insurance plan and work with the patient to get the denial overturned.

Remote: Although this position is listed as remote, the training period requires you working onsite 5 days/week for 3 months at our Middleburg Heights, OH or Milan, OH facilities after transitioning to remote.

Responsibilities:

  • Review assigned denials and EOB’s for appeal filing information. Gather any missing information.
  • Review case history, payer history, and state requirements to determine appeal strategy.
  • Obtain patient and/or physician consent and medical records when required by the insurance plan or state.
  • Gather and fill out all special appeal or review forms.
  • Create appeal letters, attach the materials referenced in the letter, and mail them.
  • Coordinate phone hearings with the insurance company, patient, and physician.
  • Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s.
  • Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks.
  • Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager.
  • Participate in team and appeal meetings by sharing the details of cases worked.
  • Act as a backup on answering incoming telephone calls as needed.
  • May undertake special projects assigned by the Team Leader or Reimbursement Manager.
  • Ability to meet predetermined Productivity Goals based on the level of Appeal.
  • Ability to meet Quality Standard in place (90% or greater).
  • Other duties as assigned.

Qualifications:

  • High School diploma or GED
  • Minimum of four years health insurance billing experience
  • Knowledge of managed care industry including payer structures, administrative rules, and government payers
  • Proficient in all aspects of reimbursement
  • Ability to maintain confidentiality
  • Detail oriented
  • Possess excellent written and verbal communication skills
  • Able to establish priorities, work independently, and proceed with objectives without supervision.
  • Proficient in using Microsoft Excel and Word

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