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Insurance Appeals Jobs in Wisconsin (NOW HIRING)

Integrated Resources INC

Appeals Clerk

Milwaukee, WI · On-site

Appeals Clerk Duration: 3+ months contract Location: Milwaukee, Wisconsin 53224 Shift: 8:00AM to 5 ... Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

Novir

Insurance Verification Representative

Milwaukee, WI · On-site

$16.75 - $21.50/hr

Support medical billing efforts by screening and updating payer data to ensure clean claims. * Follow up on unpaid or denied claims and assist in preparing insurance appeals. * Maintain detailed ...

Novir

Insurance Verification Representative

Milwaukee, WI

$16.75 - $21.50/hr

Support medical billing efforts by screening and updating payer data to ensure clean claims. * Follow up on unpaid or denied claims and assist in preparing insurance appeals. * Maintain detailed ...

Imedica

Appeals and Grievance Specialist

Madison, WI · On-site

$45K - $78K/yr

High school diploma or equivalent * 3 years of related work experience Preferred Qualifications * 3-5+ years of experience in appeals and grievances, healthcare operations, insurance, or related ...

Rennes Group, Inc.

Insurance Case Manager

WI · On-site

If needed, duties will also include initiating prior authorizations and appeals as necessary to ... Minimum of 1 year of insurance experience, including knowledge of insurance products and industry ...

RENNES GROUP

Insurance Case Manager

De Pere, WI · On-site

If needed, duties will also include initiating prior authorizations and appeals as necessary to ... Minimum of 1 year of insurance experience, including knowledge of insurance products and industry ...

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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 Wisconsin?

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

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

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

What cities in Wisconsin are hiring for Insurance Appeals jobs?

Cities in Wisconsin with the most Insurance Appeals job openings:

Insurance Appeals jobs near you
Infographic showing various Insurance Appeals job openings in Wisconsin as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution.

Appeals Specialist

Altoona, WI • On-site

Group Health Cooperative of Eau Claire
Insurance Services • 51 - 200 employees
Learn more about Group Health Cooperative of Eau Claireexternal

Full-time

Medical, Dental, Retirement, PTO

Posted 27 days ago

Job description

Position Purpose
The Appeals Specialist will be responsible for the appeals process from receipt to resolution for both provider appeals and member appeals, grievances, and complaints. This position will research and resolve complex issues related to claims and enrollment, provider payment disputes, reversals, member authorization denials, and service quality complaints. The Appeals Specialist will schedule member appeals and lead the Grievance and Appeal Committee meetings for members to appeal authorization denials and/or quality complaints. Finally, this position is responsible for tracking and reporting on data related to these processes. This position will report to the Director of Provider Relations.
Essential Position Functions
  • Coordinate the formal provider appeals process both internally for first level and externally for second level appeals. This includes, preparing and sending letters, scheduling, and leading the appeal meeting, and drafting and sending resolution.
  • Coordinate the informal provider payment dispute process and determine the necessary actions to resolve the problem.
  • Coordinate the member grievance and appeal process with Appeals Coordinator. This includes member contact and coordination (verbal and written correspondence), tracking grievances and appeal, scheduling and leading Grievance and Appeal Committee, clinical consultations with the Health Management Department, and internal and external reporting.
  • Coordinate member complaint process. This includes member contact and coordination (verbal and written correspondence), tracking complaints, scheduling and leading Grievance and Appeal Committee, and internal and external reporting
  • Research and resolve complex claims that pertain to membership or billing issues; send claim and payment reversals to appropriate staff if necessary.
  • Work closely with the Internal Coder and Claims management team to resolve billing issues. Provide education to providers if appropriate.
  • Appeals Specialist will review all decisions and generate resolution letters for member and provider appeals.
Minimum Requirements of the Position
  • Excellent verbal and written communication skills required;
  • One to two years of customer service experience focusing on customer complaint resolution is preferred;
  • Bachelor’s degree preferred or equivalent experience required;
  • Knowledge of the health insurance industry preferred;
  • Organized and attentive to detail;
  • Proficiency with Microsoft Word, Excel is required.
  • Ability to work well with many different personality types;
  • Excellent work ethic with the ability to work in a team environment as well as independently;
  • Strong analytical and problem solving skills.
Group Health Cooperative of Eau Claire complies with applicable Federal civil rights laws and does not discriminate, exclude or treat candidates less favorably on the basis of race, color, national origin (including limited English proficiency and primary language), age, disability, or sex (including sex characteristics, including intersex traits; pregnancy or related conditions; sexual orientation; gender identity; and sex stereotypes).
The Cooperative is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. The Cooperative is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees and members feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.
This full time position offers an outstanding benefit package, including three weeks of vacation the first year, a generous retirement plan, health and dental insurance, a wellness program, and much more! If you are interested in working for an organization focused on a team atmosphere and is dedicated to providing exceptional service submit your resume today! Send resume to: resumes@group-health.com. Group Health Cooperative of Eau Claire is an affirmative action and equal opportunity employer.

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