Appeals Specialist II

Are you an analytical healthcare professional who loves solving complex puzzles without being on the phone all day? We are seeking dedicated Appeals Specialists to join a high-performing Utilization Management team! In this 100% remote role, you will act as the first line of defense in evaluating claim disputes, verifying prior authorization requirements, and conducting thorough case research.

Working from the comfort of your home, you will review reconsiderations, analyze medical necessity documentation, and ensure accurate authorization updates across multiple specialized software platforms. If you thrive in an independent, task-focused environment, possess a sharp eye for detail, and bring hands-on experience with claims processing or prior authorizations, this is an outstanding opportunity to grow your healthcare revenue cycle career.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Position Summary:

Investigate claim disputes and reconsiderations to verify authorization requirements, validate existing medical authorizations, and document detailed instructions for downstream build teams.

Key Responsibilities:

• Review claims in the triage queue to evaluate authorization needs, timely filing, and medical necessity eligibility.

• Conduct in-depth research across internal systems to confirm proper authorization loading, dates of service, procedure codes, and units.

• Write detailed, clear case notes outlining findings and specific next steps for Authorization Builders and Resolution teams.

• Meet daily production benchmarks of 50 cases per day (approx. 6.25 cases per hour) while maintaining high quality standards.

Requirements:

• High School Diploma or GED required.

• 1–2 years of experience in prior authorizations, claims processing, disputes, reconsiderations, or utilization management.

• strong critical thinking and analytical capabilities to interpret guidelines and resolve complex claim issues independently.

• High computer literacy and typing proficiency (minimum 40 WPM at 95% accuracy).

• Dedicated home office setup with high-speed internet and multi-application navigation skills.

Skills

• Analytical Thinking
• Appointment Scheduling
• Basic Software Skills
• Written Communication

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.