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Remote Appeals Representative Jobs in Georgia (NOW HIRING)

Manulife

$94K - $111K/yr

This is a remote role open to any location in continental US Manulife is a leading international ... Process formal underwriting appeals and complaints. * Review underwriting fraud referrals for ...

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Remote Appeals Representative information

What does a remote appeals representative do?

A Remote Appeals Representative reviews and processes appeals from customers, often related to insurance claims, billing disputes, or service denials. They work from a remote location, communicating with clients, healthcare providers, or other stakeholders to gather necessary information and documentation. Their primary role is to assess the validity of appeals, ensure compliance with company policies and regulations, and provide clear resolutions. Attention to detail, strong communication skills, and knowledge of relevant laws and procedures are essential for this job.

What are the key skills and qualifications needed to thrive as a remote appeals representative?

To thrive as a Remote Appeals Representative, you need a solid understanding of healthcare policies, claims processing, and insurance guidelines, often supported by experience in medical billing or a related field. Familiarity with claims management software, electronic health records (EHRs), and proficiency in Microsoft Office Suite are typically required. Exceptional attention to detail, strong written communication, and problem-solving skills help individuals excel in this role. These abilities are crucial for accurately reviewing, processing, and resolving appeals while ensuring compliance and member satisfaction.

How does a remote appeals representative typically collaborate with other departments to resolve complex cases?

As a Remote Appeals Representative, you will frequently interact with departments such as claims processing, medical review, and customer service to gather necessary information and clarify case details. Collaboration often involves virtual meetings, secure messaging, and shared documentation platforms to ensure all stakeholders are aligned and have access to relevant data. This cross-functional teamwork is essential for resolving complex or escalated appeals efficiently while maintaining compliance with company and regulatory standards.

What is the difference between Remote Appeals Representative vs Remote Customer Service Representative?

AspectRemote Appeals RepresentativeRemote Customer Service Representative
Required CredentialsHigh school diploma or equivalent; some roles may require knowledge of appeals processesHigh school diploma or equivalent; customer service experience often preferred
Work EnvironmentHome-based, handling appeals cases for insurance, healthcare, or government agenciesHome-based, assisting customers with inquiries, billing, and product support
Employer & IndustryInsurance companies, healthcare providers, government agenciesRetail, telecommunications, service providers
Common Search & ComparisonAppeals process, claims review, dispute resolutionCustomer support, help desk, client assistance

The Remote Appeals Representative focuses on reviewing and resolving appeals related to claims or benefits, requiring specific knowledge of appeals procedures. In contrast, the Remote Customer Service Representative handles general customer inquiries and support. Both roles are remote, but they serve different functions within their industries.

What are the most commonly searched types of Appeals Representative jobs in Georgia?

The most popular types of Appeals Representative jobs in Georgia are:

What cities in Georgia are hiring for Remote Appeals Representative jobs?

Cities in Georgia with the most Remote Appeals Representative job openings:

Remote Appeals Representative jobs near you

Remote Medical Insurance Follow Up Rep

TRC Talent Solutions

Atlanta, GA • Remote

Full-time

Medical, Dental, Vision, Life, PTO

Posted 9 days ago

Job description

Medical Insurance Follow Up Representative 100% Remote

$1822/hour | Full-Time | Permanent Opportunity

We're growing and looking for experienced Medical Insurance Follow-Up Representatives to join our fully remote team! In this role, you will focus on back-end A/R follow-up, denial resolution, and aged account remediation for Hospital and/or Physician Billing accounts.

Our team partners with healthcare providers and hospital organizations to deliver revenue cycle and accounts receivable support services. If you thrive in a fast-paced environment, enjoy problem solving, and have experience working insurance denials and unpaid claims, we'd love to hear from you.

Why Join Us?

  • 100% Remote

  • Flexible Schedule

  • Health, Dental, Vision, and Life Insurance

  • PTO, Paid Sick Leave, and Paid Holidays

  • Career Growth Opportunities

What Youll Do:

  • Perform second-tier insurance account follow-up on outstanding A/R balances

  • Resolve denied, underpaid, and unresolved insurance claims

  • Resolve aged accounts and payer issues

  • Work high-dollar accounts and conduct detailed account research

  • Review UB-04 and/or HCFA 1500 claims for billing accuracy

  • Investigate eligibility discrepancies, coding issues, payer denials, and reimbursement variances

  • Communicate professionally with insurance payers, clients, and internal teams

  • Identify payer trends, workflow issues, and barriers to resolution

  • Submit corrected claims, rebills, secondary billing, and appeals as needed

  • Document account activity and correspondence thoroughly and accurately

  • Escalate payer errors appropriately for reprocessing

  • Work with commercial and government payers

  • Maintain productivity and quality standards

Experience & Education:

  • 1-2 years of Healthcare Revenue Cycle experience required

  • Experience with Hospital Billing and/or Physician Billing required

  • Strong knowledge of denials, insurance follow-up, UB-04 and/or HCFA 1500 claims

  • Experience using systems like Epic, Cerner, Meditech, McKesson, Allscripts, Soarian, etc.

  • Proficiency in Microsoft Office and other internet-based systems

  • Strong ability to multitask across multiple applications and systems

  • High School Diploma or equivalent required; Associate's or Bachelor's Degree preferred

Physical Requirements:

  • Ability to sit for extended periods of time

  • Frequent use of hands and fingers for typing and computer work

  • Ability to communicate via phone and computer

  • Occasionally lift up to 15 pounds