Job Title: Appeals Specialist I
Location: Fully Remote (U.S. Based)
Pay Rate: $22/hr on W2
Schedule: Monday–Friday | Standard Business Hours
Assignment Length: 06+ Months- Possibility of conversion or extension.
Target Start Date: ASAP (pending onboarding completion)
Benefits: Health, Dental, Vision
About the Role:
We are currently seeking a detail-oriented and organized Appeals Specialist I to join our team. In this fully remote role, you will be responsible for processing and managing appeal requests across all lines of business while ensuring compliance with federal, state, and accreditation standards. The ideal candidate will have a strong background in customer service or health insurance, with the ability to communicate effectively and handle sensitive issues with professionalism.
Key Responsibilities:
- Process and organize appeals, ensuring timely and accurate handling of all inquiries and documentation
- Respond to appeal requests from members, providers, the Department of Labor, and ERISA via phone, email, and letter
- Send acknowledgment letters to members and draft provider letters for director's review
- Track and log appeals in internal systems, maintaining accuracy and completeness
- Prepare summary reports and act as a liaison between departments on appeal matters
- Coordinate internal quality of care referrals and ensure complaint acknowledgments are sent within regulatory timelines
- Assist Appeals RN, grievance coordinator, and supervisor with reporting, follow-up, and special projects
- Identify appeal trends and communicate key insights to management
- Maintain confidentiality and ensure compliance with HIPAA and other corporate policies
Required Skills & Experience:
- 2+ years of experience handling health insurance claims/services inquiries
- OR
- 1+ year of health insurance experience plus 2+ years of customer service
- Strong problem-solving and analytical abilities
- Excellent organizational and time management skills
- Strong written and verbal communication skills, including professional phone etiquette
- Ability to work independently in a fast-paced, remote environment
Preferred Qualifications:
- Experience with BlueChip claims payment systems
- Understanding of medical terminology and appeals processing
- Bilingual (Spanish) preferred
- High attention to detail and ability to stay composed under pressure
If you're passionate about supporting members and ensuring quality healthcare service delivery, we'd love to hear from you. Apply today to join a mission-driven team making a difference in the healthcare space!