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Remote Appeals Representative Jobs (NOW HIRING)

MedReview

Appeals Specialist II

Manhattan, NY · Remote

... represent all responsibilities for this position. Candidate must understand and be willing and able ... frequent interruptions Remote Work Requirements * High speed internet (100 Mbps per person ...

UHS

MARKET APPEALS SPECIALIST

Brentwood, TN · Remote

This is a fully remote position. RESPONSIBILITIES: * Complete all standard appeals timely and ... Strong oral communication skills to represent patient progress and treatment in behavioral health.

Avēsis

Appeals and Grievances Coordinator

$22.50 - $28/hr

Collaborative: ability to represent your own interests while being fair to those representing other ... As this role is a remote role, you are required to maintain internet service that allows you to ...

Quantum Health

Director, Appeals

This position is remote with required travel to Dublin, Ohio (once per month for the first six ... Represent the appeals function in cross-functional committees and initiatives. * Provide reporting ...

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 ...

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

Investigates, interprets, and analyzes appeal (reconsideration) and grievance requests from multiple sources including members, authorized representatives, and providers. Responds to such requests in ...

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How much do remote appeals representative jobs pay per hour?

As of Jul 4, 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, and why are they important?

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 Specialist II

Appeals Specialist II

MedReview

Manhattan, NY • Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 days ago

Job description

Position Summary
At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare.  As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
Under the direction of the Appeals Department leaders, the Appeals Coordinator level II team member will assist Appeals leadership with daily administrative work within the department.
The Appeals Specialist level II performs research, investigation, and analysis of appeals, grievances, and other types of complaints filed by providers and clients to administer timely resolution.  Responsible for all aspects of nonclinical appeals and inquiries
Responsibilities
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of the department and NYCHSRO/MedReview in general.
  • Prepare and disseminate case file for External Reviews and/or State Fair Hearing
  • Manage and monitor all appeals from Non-Participating providers
  • Independently prepare well written, customized responses to all provider inquiries/complaints that appropriately and completely address the complainant’s issues and are structurally accurate.
  • Ensure timely review, research, and resolution of appeals, grievances, and complaints within guidelines. Ensures that all complaints are handled and resolved in compliance with timeliness requirements, and at the highest standards for accuracy
  • Consults with managers on problem cases and interfaces with clinical supervisors, account managers, and other personnel in resolving health plan requests or provider inquiries
  • Log and track grievances, appeals, and other types of complaints as needed.
  • Review and determine outcome of appeal/grievance, either independently or in conjunction with clinical appeal staff.
  • Consults with subject matter experts and resources available within organization to assist in appeal and complaint resolution.
  • Make critical decisions regarding research and investigation to appropriately resolve all inquiries
  • Serve as a liaison to Appeal Coordinator providing guidance and expertise to ensure timely resolution of cases
  • Other duties and responsibilities as assigned

Qualifications:
 
  • Associates Degree. Additional years of related experience may be used in place of education requirements
  • 3+ years’ experience working in the health care industry
  • Experience in inpatient claims, DRG and High-Cost Outlier claims preferred
  • Experience in DRG Pricing using WebStrat
  • Knowledge in claim payment methodology
  • Good MS Office skills. Particularly Excel
  • Excellent problem solving and analytical skills required
  • Ability to manage priorities in a complex environment.
  • Excellent organization and time management skills required
  • Excellent written and verbal communication skills
  • Takes initiative to proactively identify and solve problems
  • Ability to meet strict, time sensitive deadlines
  • Ability to cope well with ambiguity and stressful situations
  • Must show patience and the ability to remain calm under pressure in an atmosphere of frequent interruptions

Remote Work Requirements
  • High speed internet (100 Mbps per person recommended) with secured WIFI.
  • A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
  • Must be able to sit and use a computer keyboard for extended periods of time.

Benefits and perks include:
 
  • Healthcare that fits your needs - We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
  • 401(k) with Employer Match - Join the team and we will invest in your future
  • Generous Paid Time Off - Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
  • Wellness - We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
  • Learning & Development - Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.

Salary Range: $50,000- $55,000/ annually.  

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