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.