To Apply for this Job Click Here
Insurance Appeals Analyst
If you’re looking for a role where your expertise directly impacts members and providers, this is a great opportunity. You’ll review denied insurance claims and appeals, analyze medical records and coverage details, and help determine whether an adverse decision should be overturned—all while ensuring accuracy and regulatory compliance.
Key Responsibilities / What You’ll Do
- Investigate denied claims, member grievances, and appeals by evaluating medical records and policy documentation
- Make well-supported decisions to uphold or overturn denials with clear, thorough documentation
- Prepare written correspondence for patients and providers outlining appeal determinations
- Ensure all actions comply with state/federal regulations
- Identify and track denial trends, recommending process improvements
- Support internal teams with research and resolution of claims
- Communicate with employees/members, providers, clients, and other carriers via phone, email, messaging, fax, or letter
Qualifications / What We’re Looking For
- 2–3 years of experience in healthcare, claims, managed care, or health insurance
- Experience with self-funded insurance/benefits and/or TPA processes
- Strong knowledge of medical terminology and coding (CPT®, HCPCS Level II, ICD-10-CM)
- Familiarity with SPDs/insurance booklets or similar benefit tools
- Proficient with Microsoft Office (Excel, Word) and Teams
- Strong analytical skills, decision-making, discretion, and excellent written communication (letter writing)
Why Join the Team?
Join a collaborative, customer-focused environment where your work helps reduce backlogs and improve the appeals process. Long-term temp opportunity with strong likelihood of hire for the right candidate!
Job Details
- Job Type: Temporary (could be a great fit in the door)
- Pay / Salary: $26–$27/hour
- Hours / Schedule: 8-hour shift; 7:30am–6:30pm EST
- Location: Remote but must be within 1 hour of Lancaster, PA