Remote Appeals Specialist

TEKsystems; Lewiston (ID); Remote; USD 32,000 - 39,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Retirement Plan

Life Insurance

Short and long-term disability

Health Spending Account (HSA)

PTO / Vacation

Job summary

TEKsystems in Lewiston, ID is seeking a Contract to Hire Medical Appeals Reviewer to handle full lifecycle appeals from intake to closure, collaborating with clinicians and providers to reach timely decisions.

The role requires 4+ years in customer service or clinical services, familiarity with CPT/DX/HCPCS coding, and strong communication and multitasking skills. Fully remote work option is available.

Qualifications

• High school diploma or GED with 4 years in customer service, claims, or clinical services or an equivalent combo.
• Knowledge of medical terminology and coding (CPT, DX, HCPCS) preferred.
• Strong written and verbal communication, analytical, and multitasking skills.
• Coding certification a plus.

Responsibilities

• Validate appeal intake and document in system.
• Analyze claims, policies, and documentation to build appeal recommendations.
• Issue non-clinical determinations and coordinate clinical reviews as needed.
• Manage external review coordination and communications with all parties.
• Track appeals and support reporting on trends, volume and compliance.
• Serve as a courteous, professional contact for members/providers throughout the process.

Skills

Call Center

Customer Service

Data Entry

Computer Skills

Education

High school diploma/GED + 4 years' experience in customer service, claims, or clinical services

Tools

MS Office

Job description

TEKsystems in Lewiston, ID is seeking a Contract to Hire Medical Appeals Reviewer to handle full lifecycle appeals from intake to closure, collaborating with clinicians and providers to reach timely decisions.

The role requires 4+ years in customer service or clinical services, familiarity with CPT/DX/HCPCS coding, and strong communication and multitasking skills. Fully remote work option is available.