Remote Appeals Specialist

TEKsystems; United States; Remote; USD 34,000 - 43,000; Full time

Job summary

TEKsystems is seeking a Remote Appeals Specialist to own the full lifecycle of member and provider appeals, from intake and eligibility validation through analysis, decision, and closure. You will review claims, policies, and contracts to formulate recommendations and collaborate with coding specialists, nurses, and physician reviewers to reach timely decisions.

This contract-to-hire role is fully remote with candidates in OR, WA, UT, ID, or North Dakota and a pay range of $25.00-$31.00 per

Qualifications

• High school diploma/GED + 4 years' experience in customer service, claims, or clinical services (or equivalent combo of education/experience).
• Intermediate MS Office skills (Word, Excel, Outlook).
• Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs) preferred.
• Strong written/verbal communication, analytical, and multitasking skills.
• Coding certification a plus.

Responsibilities

• Validate appeal intake (timeliness, benefits, employer group, provider contracts) and document in system.
• Analyze claims, policies, and documentation to build appeal recommendations.
• Issue non-clinical determinations per department guidelines; coordinate clinical reviews as needed.
• Manage external review coordination, documentation, and communication with all parties.
• Track appeals and support reporting on trends, volume, and compliance.
• Serve as a courteous, professional point of contact for members/providers throughout the appeal process.

Skills

Call Center

Customer Service

Data Entry

Computer Skills

Education

High school diploma/GED

Tools

MS Office

Job description

TEKsystems is seeking a Remote Appeals Specialist to own the full lifecycle of member and provider appeals, from intake and eligibility validation through analysis, decision, and closure. You will review claims, policies, and contracts to formulate recommendations and collaborate with coding specialists, nurses, and physician reviewers to reach timely decisions.

This contract-to-hire role is fully remote with candidates in OR, WA, UT, ID, or North Dakota and a pay range of $25.00-$31.00 per