Appeals Specialist

Job Title: Appeals Specialist II
Contract Type / Duration: 6-month contract
Location: Remote
Work Hours: Monday Friday, 8:00 AM 4:30 PM or 8:00 AM 5:00 PM EST (based on schedule)
Pay Rate: $23.00/hour

We are seeking an Appeals Specialist II to support the review and processing of appeals, disputes, and reconsiderations. This role ensures cases are handled accurately, efficiently, and in compliance with regulatory and quality standards. The position involves case investigation, documentation, and coordination to drive timely resolutions.

1. Experience with claims processing, appeals, disputes, or reconsiderations
2. Knowledge of prior authorizations or utilization management (UM)
3. Strong data entry, typing (40+ WPM), and ability to navigate multiple systems

• Experience with healthcare systems such as CenPAS, TruCare, or Amisys
• Familiarity with regulatory standards (e.g., NCQA)
• Strong research, analytical, and problem-solving skills

High school diploma or GED

Not required

• Candidate must be eligible for W-2 employment
• No Corp-to-Corp (C2C) arrangements
• Must be legally authorized to work in the U.S. without current or future sponsorship

The client is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, military service, or any other non-merit-based factor.