Appeals Representative II

Job Description The Appeals Representative is responsible for reviewing, analyzing, and addressing provider inquiries and appeals via email, fax, telephone, or written correspondence in accordance with regulatory guidelines, client policy and instructions, industry standards, CMS, and state guidelines. This role ensures all appeals are set up accurately and in a timely manner, supporting the appeal process efficiently. Essential Functions & Responsibilities Receiving and analyzing appeal documentation to determine appropriate actions. Accurately setting up and initiating the appeals process timely, ensuring information aligns with provided documents. Ensuring compliance with HIPAA, CMS guidelines, and client instructions and policy standards. Utilizing applicable tools and resources to complete setup. Additional duties as assigned. Knowledge & Skills Knowledge of Medicare, Medicaid, and commercial insurance guidelines. Strong attention to detail, time management, and organizational skills. Excellent written and verbal communication skills. Knowledge of medical terminology and CPT/ICD codes. Proficiency with Microsoft applications. Education & Experience High school diploma or equivalent. 1+ years of experience in healthcare, insurance, claim processing, or customer service. 1+ years working with customers in a fast‑paced, deadline‑oriented environment. 1+ years of experience as an Appeals Representative. Strong technical skills with the ability to work across multiple software systems and work remotely with self‑management skills. Pay Range Pay Range: $20.08 - $30.06 per hour. Benefits A comprehensive benefits package is available for full‑time regular employees and includes Medical (HDHP) with Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre‑paid Legal Insurance, Parking and Transit FSA accounts, 401(k), Roth 401(k), and paid time off. Equal Opportunity Employer CorVel is an Equal Opportunity Employer, drug‑free workplace, and complies with ADA regulations as applicable. #J-18808-Ljbffr CERIS