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Insurance Appeals Jobs in Texas (NOW HIRING)

PFS Group

Insurance Appeals Rep

Houston, TX

JOB SUMMARY Under the supervision of the Insurance Supervisor, the Insurance Appeals Representative will work high dollar or complex denials for hospital insurance claims. The Appeals Representative ...

PFS Group

Insurance Appeals Rep

Houston, TX · On-site

JOB SUMMARY Under the supervision of the Insurance Supervisor, the Insurance Appeals Representative will work high dollar or complex denials for hospital insurance claims. The Appeals Representative ...

OMS MEDICAL BILLING LLC

Appeals Specialist

Addison, TX · On-site

Communicate with insurance companies, healthcare providers, and patients regarding appeal status * Maintain accurate records of all appeal activities * Analyze appeal outcomes and identify trends to ...

Dane Street

Orthopedics Physician

Harper, TX · 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 ...

Medix

Appeals Specialist

Addison, TX · On-site

$27 - $30/hr

Evaluate rejected insurance claims to diagnose root causes and formulate targeted appellate strategies. * Draft, assemble, and submit comprehensive formal appeal packages backed by robust clinical ...

CERiS

Appeals Representative II

Fort Worth, TX · Remote

$20.08 - $30.06/hr

Knowledge of Medicare, Medicaid, and commercial insurance guidelines * Strong attention to detail ... an Appeals Representative * Strong technical skills with the ability to work across multiple ...

CorVel

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

Knowledge of Medicare, Medicaid, and commercial insurance guidelines * Strong attention to detail ... an Appeals Representative * Strong technical skills with the ability to work across multiple ...

CERIS Health

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

Knowledge of Medicare, Medicaid, and commercial insurance guidelines * Strong attention to detail ... an Appeals Representative * Strong technical skills with the ability to work across multiple ...

CERiS

Appeals Representative II

Fort Worth, TX · Remote

$18.80 - $30.34/hr

The Appeals Representative is responsible for addressing provider inquiries and appeals via email ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

CERiS

Appeals Representative II

Fort Worth, TX · On-site +1

$18.80 - $30.34/hr

The Appeals Representative is responsible for addressing provider inquiries and appeals via email ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Corvel

Appeals Representative II

Fort Worth, TX · On-site

$20.08 - $30.06/hr

Knowledge of Medicare, Medicaid, and commercial insurance guidelines * Strong attention to detail ... an Appeals Representative * Strong technical skills with the ability to work across multiple ...

Corvel

Appeals Representative II

Fort Worth, TX · On-site +1

$18.80 - $30.34/hr

The Appeals Representative is responsible for addressing provider inquiries and appeals via email ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Corvel

Appeals Representative II

Fort Worth, TX · Remote

$18.80 - $30.34/hr

The Appeals Representative is responsible for addressing provider inquiries and appeals via email ... Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and ...

Corvel

Appeals Representative II

Fort Worth, TX · Remote

$20.08 - $30.06/hr

Knowledge of Medicare, Medicaid, and commercial insurance guidelines * Strong attention to detail ... an Appeals Representative * Strong technical skills with the ability to work across multiple ...

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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 Texas?

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

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

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

What cities in Texas are hiring for Insurance Appeals jobs?

Cities in Texas with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Texas as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 19% Part Time, 6% Contract, and 1% Nights. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution.

Insurance Appeals Rep

PFS Group

Houston, TX

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 15 days ago

Job description

JOB SUMMARY

Under the supervision of the Insurance Supervisor, the Insurance Appeals Representative will work high dollar or complex denials for hospital insurance claims. The Appeals Representative will be responsible for reviewing basic clinical documentation and relevant payer guidelines to draft timely and effective appeals. They will be measured on appeals success and denials overturn rate, working to improve cash collections on behalf of their client(s). The Appeals Representative may directly write appeals or act as a consultant for other Insurance Reps, assisting them with referencing clinical or payer guidelines. They may be expected to share payer updates with Insurance teams or provide occasional information sessions to department trainer or representatives. They will prioritize work based on feedback from their leadership in order to best impact performance metrics.

ESSENTIAL FUNCTIONS

  1. Demonstrate extensive knowledge of insurance follow-up and denials.
  2. Act as the subject matter expert for appeals on their team.
  3. Triage and determine denial reasons from remittance advice, explanation of benefits, payer portals, or other avenues of information.
  4. Research pertinent payer medical policy bulletins and billing guidelines, creating a repository of reference materials for themselves and other team members.
  5. Prioritize work effort by viability and amount of payment to maximize cash.
  6. Track payer issues and escalations to provide relevant trending information to leadership.
  7. Follow appeals to resolution to assess effectiveness.
  8. Create job aids and share information on appeals language as needed.
  9. Practice compliant billing and follow-up strategies for all government and managed care payers.
  10. Meet minimum of 10 appeals per day, as well as any follow-up needed on existing appeals.
  11. Aggressively seek to resolve unpaid balances.
  12. Document all efforts accurately and thoroughly.
  13. Follow all workflow protocols.
  14. Work other insurance inventory as assigned or as volume demands.

KNOWLEDGE, SKILLS, AND ABILITIES

  1. Outstanding research and follow-up skills.
  2. Deep knowledge of denial types and causes.
  3. Ability to research commercial, managed care, and government payer guidelines and reference language in all appeals.
  4. Ability to read and interpret remittance advice/explanation of benefits.
  5. Strong written and verbal communication skills, especially when drafting appeals or creating workflow templates for teammates.
  6. Self-motivation and ability to work autonomously.
  7. Basic analytics, to include Microsoft Excel.

EDUCATION AND EXPERIENCE

  1. At least 6 months as an Insurance Representative at PFS Group, or 12 months of equivalent experience from a comparable organization.
  2. At least 2 years of hospital insurance follow-up or denials experience.
  3. Epic experience, with strong preference toward HB, required.

Preferences 

  1. CUBS experience

PFS Group

Nationwide Patient Account Management Firm.

Based in Houston, Texas, we currently work with 32+ clients who operate more than 100 hospital facilities from small, rural community medical centers to metro population center health systems. Leaders in their respective markets and nationwide, our clients rely on our services to support their accounts receivable departments.

PFS Group offers a friendly, caring work environment, with competitive benefits and compensation, (medical, dental, vision, short and long-term disability, life insurance, hospital indemnity, critical illness, accident insurance and a matching 401(k) and Zayzoon!

If you are looking for a position in a dynamic, fast-paced organization with career growth opportunities, come grow with us! www.pfsgroup.org

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