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How much do medicare appeals jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for medicare appeals in the United States is $25.71, according to ZipRecruiter salary data. Most workers in this role earn between $19.71 and $30.53 per hour, depending on experience, location, and employer.

What is a Medicare Appeals?

A Medicare Appeals job involves reviewing and processing appeals related to Medicare coverage decisions. Professionals in this role assess denied claims, gather supporting documentation, and communicate with healthcare providers, patients, and Medicare representatives. They ensure compliance with Medicare regulations while advocating for fair reconsiderations. Strong knowledge of Medicare policies and attention to detail are essential for success in this field.

What are some common challenges faced by professionals working in Medicare Appeals?

Professionals in Medicare Appeals often encounter challenges such as navigating complex and frequently changing Medicare policies, managing tight deadlines for appeals submissions, and ensuring the accuracy and completeness of documentation. The role requires balancing extensive administrative work with direct communication with providers, patients, and insurance representatives to gather necessary information and clarify appeal cases. Staying organized and up-to-date on regulatory changes is crucial for success, and many find that strong teamwork with billing, coding, and compliance departments helps streamline the appeals process. Despite these challenges, the work can be highly rewarding, especially when successful appeals lead to improved patient outcomes and financial stability for healthcare organizations.

What are the key skills and qualifications needed to thrive in the Medicare Appeals position, and why are they important?

To thrive in Medicare Appeals, professionals need a thorough understanding of Medicare regulations, medical billing, and claims processes, often requiring experience in healthcare administration or a related field. Familiarity with appeals management software, electronic health records (EHR) systems, and government health portals is highly beneficial, and some employers may prefer certification as a Certified Professional Coder (CPC) or Certified Professional in Healthcare Quality (CPHQ). Attention to detail, strong analytical thinking, and excellent written and verbal communication skills are vital soft skills in this role. Mastery of these skills is critical for ensuring accurate appeal submissions, effective collaboration with stakeholders, and positive outcomes for both patients and healthcare organizations.

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Medicare Appeals jobs near you
Infographic showing various Medicare Appeals job openings in the United States as of August 2026, with employment types broken down into 5% As Needed, 77% Full Time, 14% Part Time, and 4% Contract. Highlights an 86% Physical, 2% Hybrid, and 12% Remote job distribution, with an average salary of $53,482 per year, or $25.7 per hour.

Member Appeals & Grievances Specialist I

VIVA Health

Birmingham, AL • Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 13 days ago

Viva Health rating

8.1

Company rating: 8.1 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

156th of 310 rated insurance

Job description

Member Appeals & Grievances Specialist

Location: Birmingham, Alabama

Work Schedule: This position will primarily work from the VIVA HEALTH headquarters in downtown Birmingham.  After training has been completed, there would be an opportunity to work 1 day per week from home.

Job Summary

The Member Appeals & Grievances Specialist will analyze and resolve all Medicare appeals and grievances received from members, non-contracted providers and government entities. This role will coordinate a timely resolution according to state and federal guidelines and VIVA HEALTH policies and procedures. This position will participate in an on-call rotation to process appeals and grievances on weekends and holidays.

Why VIVA HEALTH?

VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.

VIVA HEALTH has been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.

Benefits

  • Comprehensive Health, Vision, and Dental Coverage
  • 401(k) Savings Plan with company match and immediate vesting
  • Paid Time Off (PTO)
  • 9 Paid Holidays annually plus a Floating Holiday to use as you choose
  • Tuition Assistance
  • Flexible Spending Accounts
  • Healthcare Reimbursement Account
  • Paid Parental Leave
  • Community Service Time Off
  • Life Insurance and Disability Coverage
  • Employee Wellness Program
  • Training and Development Programs to develop new skills and reach career goals
  • Employee Assistance Program

See more about the benefits of working at Viva Health - https://www.vivahealth.com/careers/benefits

Key Responsibilities

  • Process member and non-contracted provider Medicare Part C and Part D grievances and appeals according to federal and state regulations and internal, organizational policies and procedures.
  • Collaborate with internal and external subject matter experts to obtain benefit and/or clinical opinions/interpretations.
  • Identify training, process improvement, and other ways to maximize plan performance and customer satisfaction.
  • Act as subject matter expert regarding grievances and appeals.
  • Prepare for and participate in all required audits.
  • Participate in on-call rotation on weekends and holidays.

REQUIRED QUALIFICATIONS:

  • High School diploma or GED
  • 1 – 3 years’ experience in managed care, health care customer service, or appeals and grievances
  • Excellent written and verbal communication skills, interpersonal skills, organization skills, and the ability to handle multiple tasks
  • Ability to carefully follow processes in sequential order
  • Ability to meet established productivity, schedule adherence, and quality standards
  • Knowledge of computer platforms and applications of Microsoft Office
  • Ability to use critical thinking skills to develop solutions to non-clinical issues using fact-based decision making
  • Ability to work occasional planned and unplanned overtime to meet deadlines with minimal supervision

PREFERRED QUALIFICATIONS:

  • Associates’ Degree
  • Experience working with the elderly population
  • 1 – 3 years’ experience processing Medicare appeals and grievances
  • Knowledge of Medicare regulations
  • Experience with administrative and/or coordinator positions with exposure to PHI

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