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If you're looking for a meaningful healthcare role where your analytical skills can make a direct impact on members and providers, this is an excellent opportunity to join a leading healthcare organization. You'll play a key role in resolving complex appeals and grievances while ensuring compliance with important regulatory standards in a collaborative, fully remote environment.
Location: Remote*
Pay Rate: $30-$33/hour
Employment Type: 6-Month Contract
Schedule: Monday-Friday, 8:00 AM-5:00 PM
Why This Role Matters
As an Appeals Analyst, you'll help ensure members and providers receive accurate, timely resolutions to appeals, grievances, and coding disputes. Your work will directly support regulatory compliance, quality outcomes, and exceptional service delivery.
What You'll Do
• Analyze, research, resolve, and respond to appeals, coding disputes, grievances, and coverage determinations
• Interpret and explain health plan benefits, policies, procedures, medical terminology, and coding information to members and providers
• Prepare case files and develop position statements for external reviews and independent review organizations
• Conduct detailed investigations and document findings, actions, and outcomes in applicable systems
• Monitor reports and workflows to ensure service level agreements and compliance requirements are met
• Collaborate with Medical Directors and internal teams to gather information and support appeal and grievance processes
• Prioritize assigned caseloads, communicate with providers and internal stakeholders, and prepare response letters as needed
What We're Looking For
• A current, up-to-date resume
• Bachelor's degree and at least 3 years of related experience, or 5 years of related experience in lieu of a degree
• Experience interpreting healthcare policies, appeals, grievances, claims, or insurance-related processes
• Knowledge of CMS guidelines and insurance industry regulations
• Strong time management, analytical, and decision-making skills
• Appeals and grievance experience preferred
• For coding dispute functions, ability to obtain Certified Professional Coder (AAPC) certification within one year of employment
• Ability to meet compliance requirements
• Must be eligible and provide proof of eligibility to work in the US
What's In It For You
• Fully remote opportunity with a respected healthcare organization
• Comprehensive training program including classroom learning and job shadowing
• Opportunity to develop expertise in appeals, grievances, and healthcare regulations
• Collaborative environment supporting professional growth and development
• Potential for future conversion based on performance
Benefits for Manpower Associates (Upon Eligibility)
Upon completion of waiting period associates are eligible for:
• Medical and Prescription Drug Plans
• Dental Plan
• Supplemental Life Insurance
• Short Term Disability Insurance
• 401(k)
* Remote Eligibility: Remote workers must reside in one of the following states to be eligible for this remote opportunity: North Carolina, Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, Wyoming.