Appeals Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Appeals Specialist based in the United States.

As an Appeals Specialist, you will play an essential role in managing and resolving healthcare-related appeals while ensuring fair, accurate, and timely decisions for members and providers. You will oversee the full appeals process, from initial receipt and investigation to case resolution, working with internal clinical teams, medical directors, utilization management, and claims departments. Through careful research, effective communication, and thorough documentation, you will help ensure that every appeal is handled in accordance with applicable policies and regulatory requirements. You will also serve as an important point of contact for members, healthcare providers, and other stakeholders, providing clear guidance throughout the review process. This role offers the opportunity to contribute directly to healthcare quality, operational excellence, and positive member experiences. You will join a collaborative, mission-driven environment that values accuracy, accountability, and compassionate service.