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Remote Appeals Representative Jobs (NOW HIRING)

CVS Health

Medical Director - Medicare Appeals

$174K - $374K/yr

This is a remote based (work at home) based anywhere in the US.** Responsibilities of this Medical ... represents the base hourly rate or base annual full-time salary for all positions in the job grade ...

Singing River Health System

Denials/Appeals Analyst

Lingle Building, Remote Mississippi Summary Position Overview: The Denials and Appeals Analyst ... The Analyst works closely with third party payors, Managed Care representatives, insurance billing ...

Natera

Manager, Revenue Cycle (Post-Appeals)

OR · On-site +1

This role is responsible for overseeing a large remote team (offshore and onshore) focused on ... Oversee day-to-day operations of the Unresponded team, including an offshore team of 124+ reps with ...

CVS Health

Appeals Nurse Consultant

$66K - $142K/yr

Remote Work Expectations * This is a 100% remote role; candidates must have a dedicated workspace ... represents the base hourly rate or base annual full-time salary for all positions in the job grade ...

Centene

Remote Medical Director, Appeals

Lincoln, WA · On-site +1

$236K - $449K/yr

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 ...

Centene

Remote Medical Director, Appeals

Auburn, WA · On-site +1

$236K - $449K/yr

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 ...

Centene

Remote Medical Director, Appeals

OR · On-site +1

$236K - $449K/yr

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 ...

Centene

Remote Medical Director, Appeals

Trout Lake, WA · On-site +1

$236K - $449K/yr

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 ...

Centene

Remote Medical Director, Appeals

$236K - $449K/yr

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 ...

Centene

Remote Medical Director, Appeals

White Salmon, WA · On-site +1

$236K - $449K/yr

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 ...

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

Quincy, WA · On-site +1

$236K - $449K/yr

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 ...

Scanhealthplan

Grievances and Appeals (GAD) Coordinator

$20.14 - $29.16/hr

The Job The GAD Coordinator coordinates the work of a team of Member Services Representatives that ... Partially Remote * An annual employee bonus program * Robust Wellness Program * Generous paid-time ...

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Remote Appeals Representative information

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$12

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How much do remote appeals representative jobs pay per hour?

As of Sep 5, 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 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 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

Medical Director - Medicare Appeals

CVS Health

Remote

$174K - $374K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 10 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,364 frontline employees who took The Breakroom Quiz

92nd of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

Aetna, a CVS Health Company, a Fortune 6 company, is one of the oldest and largest national insurers. That experience gives us a unique opportunity to help transform health care. We believe that a better care system is more transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care resources.
**This is a remote based (work at home) based anywhere in the US.**
Responsibilities of this Medical Director role are related to Medicare Appeals:
* Direct daily work on part C appeals (both provider and member/nonparticipating providers)
* Provide direct support to appeal nurses; supervision and participation in the Second Look Review (SLR) process
* Provide after hours and weekend coverage on a rotational basis to support 24/7 appeals work
* IRE monitoring and tracking and Utilization Management Strategy support
* Collaborative work with Medicare Quality and Compliance on an ongoing basis
* Develop subject matter expertise on Medicare policy for the enterprise
* Provide ongoing education regarding Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff
* Participate in ongoing initiatives to improve appeals team efficiency and clinical consistency


Required Qualifications

* Two (2) or more years of experience in a Health Care Delivery System e.g., Clinical Practice or Health Care Industry
* Medical License (MD) or (DO)
* An Active state medical license without encumbrances
* Board Certified in ABMS or AOA Recognized Specialty


Preferred Qualifications
* Medical Management - Medicare Complaints, Grievance & Appeals experience.
* Health Plan Experience Highly Preferred

Education:

MD or DO

Pay Range

The typical pay range for this role is:

$174,070.00 - $374,920.00


This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 09/25/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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