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Remote Medicare Appeals 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 Director role are related to Medicare Appeals: * Direct daily work on part C appeals (both provider ...

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Remote Medicare Appeals information

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$5

$25

$31

How much do remote medicare appeals jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for remote 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 remote Medicare appeals specialist?

A Remote Medicare Appeals Specialist is a professional who works from home or another remote location to handle the appeals process for Medicare claims that have been denied or disputed. Their responsibilities include reviewing denied claims, gathering supporting documentation, communicating with healthcare providers and patients, and submitting appeals to Medicare or related agencies. They must have a strong understanding of Medicare regulations and guidelines, as well as attention to detail and strong communication skills. This role is commonly found in hospitals, insurance companies, and third-party billing services seeking to ensure proper reimbursement for healthcare services.

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

To thrive as a Remote Medicare Appeals Specialist, you need in-depth knowledge of Medicare regulations, claims processing, and appeals procedures, typically supported by experience in healthcare administration or medical billing. Familiarity with claims management software, electronic health record (EHR) systems, and regulatory databases is essential. Strong analytical skills, attention to detail, and effective written and verbal communication are critical soft skills in this role. These abilities ensure accurate review and resolution of appeals, compliance with complex guidelines, and clear communication with providers and beneficiaries.

What are some common challenges faced by professionals working in remote Medicare appeals, and how can they be effectively managed?

Professionals in remote Medicare appeals often encounter challenges such as navigating complex regulations, managing high caseloads, and communicating efficiently with healthcare providers and beneficiaries. Staying updated with frequently changing CMS guidelines is crucial to ensure accurate and timely submissions. Effective time management, strong attention to detail, and regular communication with team members help overcome these challenges and maintain a high standard of work. Utilizing secure, reliable digital tools and participating in ongoing training can also streamline remote workflows and improve outcomes.

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

AspectRemote Medicare AppealsRemote Medicare Customer Service Representative
Required CredentialsKnowledge of Medicare policies, certification in appeals processes often preferredCustomer service skills, basic Medicare knowledge, sometimes certification
Work EnvironmentHome-based, office setting, healthcare or insurance companyHome-based, call center or insurance provider environment
Employer & Industry UsageInsurance companies, healthcare providers, government agenciesInsurance companies, healthcare providers, customer support centers
Search & Comparison IntentUnderstanding appeals process, specialized role in claims resolutionGeneral customer support, billing, and account inquiries

Remote Medicare Appeals specialists focus on reviewing and resolving denied Medicare claims, requiring specific knowledge of appeals procedures. In contrast, Remote Medicare Customer Service Representatives handle general inquiries, billing, and customer support related to Medicare. Both roles are home-based and serve the healthcare insurance industry, but they differ in responsibilities and required expertise.

More about Remote Medicare Appeals jobs

What cities are hiring for Remote Medicare Appeals jobs?

Cities with the most Remote Medicare Appeals job openings:

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

The most popular types of Medicare Appeals jobs are:

What states have the most Remote Medicare Appeals jobs?

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

What job categories do people searching Remote Medicare Appeals jobs look for?

The top searched job categories for Remote Medicare Appeals jobs are:

Remote Medicare Appeals jobs near you
Infographic showing various Remote Medicare Appeals job openings in the United States as of August 2026, with employment types broken down into 85% Full Time, 5% Part Time, and 10% Contract. Highlights an 100% Remote job distribution, with an average salary of $53,482 per year, or $25.7 per hour.

Medical Director - Medicare Appeals

CVS Health

Remote

$174K - $374K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 12 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,370 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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