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Remote Appeals Representative Jobs (NOW HIRING)

TMF Health Quality Institute

Appeals Professional (Part C)

Austin, TX · On-site +1

$98K - $116K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

This position is located Remote United States* *This position requires working weekends, and ... Responds to and ensures that all issues raised by the beneficiary, representative, supplier, and ...

Lancesoft - Viren

Be Seen First

Healthcare - Appeals Specialist I

The Woodlands, TX · Remote

$19.92 - $21.92/hr

Remote, CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 15 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE ... representatives) in accordance with the standards and requirements established by the Centers for ...

New

WPS

Appeals Registered Nurse

Madison, WI · On-site +1

$30.50 - $40.25/hr

  • Medical

  • Dental

  • Retirement

  • PTO

Work Location We are open to remote work in the following approved states: Colorado, Florida ... Work with and provide directions to Redetermination Representatives to ensure all redeterminations ...

WPS Health Solutions

Appeals Registered Nurse

$31 - $41/hr

  • Medical

  • Dental

  • Retirement

  • PTO

We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois ... Work with and provide directions to Redetermination Representatives to ensure all redeterminations ...

WPS Health Solutions

Appeals Registered Nurse

Madison, WI · On-site +1

  • Medical

  • Dental

  • Retirement

  • PTO

Work Location We are open to remote work in the following approved states: Colorado, Florida ... Work with and provide directions to Redetermination Representatives to ensure all redeterminations ...

Moda Health

Appeal Coordinator I, Govt Programs

Milwaukie, OR · On-site +1

$21.30 - $23.96/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Investigate and respond to medical, pharmacy and dental grievances, complaints, appeals, and ... A reliable, high-speed, hard-wired internet connection required to support remote or hybrid work.

Managed Staffing

Collections Representative

TX · Remote

$25 - $26/hr

Collections Representative - Remote (TX) Location: Remote (Must reside in Texas) Schedule: Monday ... Submit appeals, find authorizations, and correct claim errors. * Conduct outbound calls and use ...

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

  • Medical

  • Retirement

  • PTO

Represents the business unit at appropriate state committees and other ad hoc committees. * May be required to work weekends and holidays in support of business operations, as needed. Education ...

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Remote Appeals Representative information

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How much do remote appeals representative jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for remote appeals representative in the United States is $24.55, according to ZipRecruiter salary data. Most workers in this role earn between $14.90 and $28.85 per hour, depending on experience, location, and employer.

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 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 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 cities are hiring for Remote Appeals Representative jobs?

Cities with the most Remote Appeals Representative job openings:

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

The most popular types of Appeals Representative jobs are:

What states have the most Remote Appeals Representative jobs?

States with the most job openings for Remote Appeals Representative jobs include:

Remote Appeals Representative jobs near you

Appeals Professional (Part C)

TMF Health Quality Institute

Austin, TX • On-site, Remote

$98K - $116K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 5 days ago

Job description

**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote United States*
*This position requires working weekends, and rotating holidays as needed *
*Please note the start date is on or after July 6, 2026*
Position Purpose:
Provides dissatisfied parties to a Medicare appeal the opportunity to present documentation or evidence to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines.
Essential Responsibilities:
  • Reviews medical records/case file, writes a decision that is clear, concise, and impartial and supports the determination made, and documents review.
  • Makes sound, independent decisions based on medical evidence in accordance with statutes, regulation, rulings, and policy.
  • Responds to and ensures that all issues raised by the beneficiary, representative, supplier, and provider have been addressed.
  • Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
  • Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.

Minimum Qualifications
Education
  • Associate's degree or 60 or more credit hours towards a Bachelor's degree from an accredited college or university in healthcare or related discipline
    • Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for Associate's degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)

Experience
  • One (1) year of Medicare appeals, medical review, clinical, healthcare regulatory interpretation/application, healthcare compliance or related experience in a healthcare setting
  • Medicare Part C related appeals activities, preferred
  • Resided in the United States for a minimum of three (3) years out of the last five (5) years (Per Contract Requirement)

Benefits
C2C offers an excellent benefits package, including:
  • Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
  • Section 125 plan
  • 401K
  • Competitive salary
  • License/credentials reimbursement
  • Tuition Reimbursement

EOE Vet/Disability
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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