Appeals Specialist I

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 I based in the United States.

• This fully remote role offers the opportunity to support members and providers by researching, evaluating, and resolving healthcare appeals and complaints.
• You’ll investigate claims, grievances, disputes, and reconsideration requests while ensuring decisions are accurate, well documented, and timely.
• The position requires a strong understanding of healthcare claims, benefits, contracts, and applicable Medicare and Medicaid requirements.
• You’ll work with medical records, claims systems, provider information, and regulatory guidelines to determine appropriate outcomes.
• Clear communication will be essential as you explain resolutions to members, providers, authorized representatives, and external agencies.
• You’ll also help identify root causes of payment issues and contribute to accurate, compliant written correspondence.
• This is a structured, detail-oriented opportunity for a healthcare operations professional who values accuracy, accountability, and member-focused service.