ZipRecruiter

Log In

1

Senior Appeals Representative Jobs (NOW HIRING)

Travis County

Attorney V - VII - Appellate

Austin, TX · On-site

$105K - $121K/yr

Job Summary The Travis County Attorney's Office is seeking a senior appellate attorney to handle ... Provide legal representation and advice to the County Attorney, the District Attorney, and county ...

Evergreen Health

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... the appeal lifecycle. Communicates with payer representatives, contributes to denial prevention ... senior team members or leadership as appropriate. 6. Reviews and validates denial trends and ...

EvergreenHealth

Denial Management Specialist

Kirkland, WA · Remote

$28.83 - $46.14/hr

... the appeal lifecycle. Communicates with payer representatives, contributes to denial prevention ... senior team members or leadership as appropriate. 6. Reviews and validates denial trends and ...

previous page

Showing results 41-60

All JobsAppeals Representative JobsSenior Appeals Representative Jobs

Senior Appeals Representative information

See salary details

$12

$24

$50

How much do senior appeals representative jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for senior 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 senior appeals representative do?

A Senior Appeals Representative is responsible for reviewing and processing appeals related to insurance claims, benefits, or coverage decisions. They analyze complex cases, evaluate supporting documentation, and communicate with policyholders, providers, and other stakeholders to ensure fair outcomes. These professionals often work with regulatory guidelines to resolve escalated or disputed claims and may mentor junior staff members. Their goal is to ensure appeals are handled efficiently, accurately, and in compliance with company policies and industry regulations.

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

To thrive as a Senior Appeals Representative, you need strong analytical skills, in-depth knowledge of insurance regulations, and experience in claims processing, often supported by a bachelor’s degree or equivalent work history. Familiarity with claims management systems, Microsoft Office Suite, and sometimes certification in medical billing or coding is typically required. Excellent communication, attention to detail, and problem-solving abilities help you effectively resolve complex appeals and collaborate with stakeholders. These skills are crucial for ensuring accurate and timely resolution of appeals, maintaining compliance, and supporting customer satisfaction.

What are some common challenges faced by senior appeals representatives, and how can they be effectively managed?

Senior Appeals Representatives often encounter challenges such as handling complex cases that require thorough knowledge of healthcare policies and regulations, managing high caseloads, and navigating tight deadlines. Staying organized and continuously updating one's knowledge on industry changes are crucial for success. Collaboration with clinical staff and other departments is essential to gather necessary information and resolve appeals efficiently. Proactive communication and attention to detail also help ensure appeals are processed accurately and timely, which can lead to better outcomes for both the company and its clients.

What is the difference between Senior Appeals Representative vs Appeals Coordinator?

AspectSenior Appeals RepresentativeAppeals Coordinator
Required CredentialsHigh school diploma or equivalent; experience in appeals processes; strong communication skillsHigh school diploma or equivalent; basic understanding of appeals procedures; organizational skills
Work EnvironmentCustomer service settings, insurance companies, healthcare organizationsAdministrative offices, healthcare facilities, insurance providers
Employer & Industry UsageCommon in healthcare, insurance, and government sectorsUsed across similar industries for managing appeals processes
Comparison Search IntentUnderstanding senior-level responsibilities in appealsLearning about coordination and administrative support roles

The Senior Appeals Representative typically handles complex appeals, requiring more experience and advanced communication skills. In contrast, the Appeals Coordinator focuses on organizing and supporting the appeals process, often with less experience required. Both roles are vital in healthcare and insurance industries, but the Senior Appeals Representative usually manages higher-level cases and decision-making.

What cities are hiring for Senior Appeals Representative jobs?

Cities with the most Senior 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 Senior Appeals Representative jobs?

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

Senior Appeals Representative jobs near you

Senior Manager, Pricing (Pharmacy Reimbursement Appeals)

CVS Health

Remote

$75K - $165K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 16 hours ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,338 frontline employees who took The Breakroom Quiz

89th of 112 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
The Senior Manager, Pricing will lead a team colleagues and contractors in the management of pharmacy reimbursement appeals. In this role, you will ensure the appeals are executed under tight Turnaround Times (TATs) and with high accuracy while making sure the team is appropriately staffed and organized. In addition, you will be responsible for developing and implementing solutions individually and being a lead working with partners to improve and automate processes to increase productivity and fulfill state regulatory changes. You will be leading and coaching the appeal team coordinators as well as guiding other internal business units to resolve issues quickly. The Senior Manager, Pricing is also responsible for working legal and compliance team to ensure state regulatory update are operationalized. This role requires a thorough knowledge of claim adjudication, internal appeal related processes, and being a leader working with other internal business units to develop new solutions to meet the ever-increasing number of complex appeal bill compliance requirements. The position will be responsible for quality control process to ensure compliance.

What you will do

  • Leads with strategic leadership and guidance to appeals teams, ensuring effective pricing strategies and operations are effectively progressed that improve work area profitability and revenue growth.
  • Analyzes competitive insights to generate actionable recommendations, supporting operational decisions and improving market competitiveness.
  • Collaborates cross-functionally with legal, finance, and account teams to align pricing strategies with business goals and enhance value propositions.
  • Influences stakeholders through effective communication and negotiation, leveraging pricing expertise and industry knowledge to establish mutually beneficial partnerships and agreements.
  • Applies experienced-based pricing knowledge and insights to influence strategic decision-making, contributing to the development of pricing policies, initiatives, and market positioning.
  • Counsels and mentor pricing team members, providing guidance and support to enhance their pricing skills and professional development.
  • Delivers pricing solutions and recommendations that drive profitability and revenue optimization and contribute to the overall financial success of the organization.


Required Qualifications

  • 7 year's experience in pricing, PBM/healthcare operations, process improvement, quality, analytics, or related domains
  • 5+ years directly leading operations teams
  • 1+ years' experience with pharmacy appeal related processes and state regulations, and claims adjudication, including claims adjudication logic


Preferred Qualifications

  • Excellent leadership skills
  • Proficient in Excel, MS Access, Salesforce, and Pharmacy Portal
  • Ability to work under tight deadlines
  • Strong mathematical problem-solving skills
  • Prior PBM Knowledge
  • Familiarity with wholesaler invoices


Education

Bachelor's Degree or equivalent experience required.

Pay Range

The typical pay range for this role is:

$75,400.00 - $165,954.00


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: 08/31/2026

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

What CVS Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply