Senior Payer Appeals Lead (Remote)

Big Health; United States; Remote; USD 120,000 - 140,000; Full time

Job summary

Big Health seeks a Senior Appeals & Denials Resolution Manager to establish and lead payer appeals and denial resolution operations across the United States. You will investigate difficult denials, craft persuasive evidence-based appeals, and drive cases through all review levels while building scalable workflows and quality controls.

AI-enabled tools will support efficiency with human oversight. You will design standardized procedures, manage complex denials, and collaborate with payer

Qualifications

• Strong experience in healthcare reimbursement or payer appeals.
• Excellent written and verbal communication with payers.
• Ability to design and improve operational workflows and processes.
• Experience with data analysis to inform decisions.

Responsibilities

• Manage end-to-end appeals from denial intake to resolution.
• Handle complex medical necessity, investigational, and coding denials.
• Develop case-specific appeal strategies with supporting documentation.
• Oversee AI-enabled appeals workflows while ensuring accuracy and compliance.
• Provide leadership, reporting, and KPIs for the appeals function.

Skills

Appeal writing

Payer communication

Analytical problem solving

Operational workflows

Data analysis

Education

Bachelor’s degree in healthcare administration, business, health sciences, or related discipline

Job description

Big Health seeks a Senior Appeals & Denials Resolution Manager to establish and lead payer appeals and denial resolution operations across the United States. You will investigate difficult denials, craft persuasive evidence-based appeals, and drive cases through all review levels while building scalable workflows and quality controls.

AI-enabled tools will support efficiency with human oversight. You will design standardized procedures, manage complex denials, and collaborate with payer