Senior Appeals Specialist – Hybrid (Charlotte)

Transformcap; Charlotte (NC); Hybrid; USD 31,000 - 39,000; Full time

Job summary

Judi Health is seeking a Senior Coordinator, Appeals, in Charlotte, NC. You will monitor, handle and escalate appeals, supporting the TPA team with daily operations including NSA/IDR, root cause analysis, and policy development to improve efficiency.

You will collaborate with product and other stakeholders to refine processes, log and track cases, and ensure accurate documentation while maintaining timely, compliant resolutions.

Qualifications

• Bachelor’s degree preferred.
• 3+ years of TPA/health plan experience in Claims Adjudication, Appeals, or related area.
• Advanced knowledge of appeals workflows and documentation requirements.
• Ability to interpret multiple client plan designs and SPDs.
• Familiarity with NSA regulations and the IDR process.
• Exceptional written and verbal communication skills.

Responsibilities

• Drives cross-functional collaboration to enhance Judi Health operations.
• Investigate and resolve client, patient, or provider disputes regarding coverage and claims.
• Monitor appeal deadlines and ensure regulatory-compliant communications.
• Log case information, upload documentation, and maintain records of processed appeals.
• Recommend process improvements to increase efficiency and quality.
• Identify and escalate operational/discrepancy issues to prevent care disruption.
• Develop policies, training materials, and educate cross-functional teams.
• Maintain quality levels and SLA response times.
• Support general business needs as assigned.
• Adhere to Judi Health Code of Conduct and report noncompliance.

Skills

Attention to detail

Verbal and written communication

Time management

Collaborative teamwork

Regulatory compliance

Education

Bachelor’s degree preferred

Tools

CPT

HCPCS

ICD-10

CDT coding

Job description

Judi Health is seeking a Senior Coordinator, Appeals, in Charlotte, NC. You will monitor, handle and escalate appeals, supporting the TPA team with daily operations including NSA/IDR, root cause analysis, and policy development to improve efficiency.

You will collaborate with product and other stakeholders to refine processes, log and track cases, and ensure accurate documentation while maintaining timely, compliant resolutions.