Appeals specialist ii

Overview We are seeking a detail-oriented and highly adaptable professional to join our fully remote team, focusing on managing cases across multiple Medicaid health plans. In this role, you will evaluate case files, resolve provider disputes, and process reconsideration requests. You will work in a highly collaborative virtual environment-engaging in daily team huddles, video calls, and 1:1 meetings with leadership-to ensure accurate and timely claim resolutions. Key Responsibilities Review, evaluate, and resolve provider disputes and reconsideration requests from healthcare facilities and providers. Navigate internal case management systems to analyze claims and determine appropriate resolutions. Modify and manage medical authorizations as needed. Partner and communicate effectively with Utilization Management (UM) and claims departments. Consistently meet established daily case-review productivity targets while maintaining a monthly quality average of 95% or higher. Actively participate in a structured remote onboarding program to learn new processes, systems, and health plan specifics. Qualifications & Requirements Experience: Minimum of 2 years of experience handling appeals, claims, and authorizations. Industry Background: Previous roles in Utilization Management, medical billing/coding, or claims processing are highly preferred. Knowledge Base: understanding of medical claims, billing/coding practices, and authorization workflows. Technical Skills: Proficient data entry and typing skills (minimum 40 WPM) with the ability to quickly learn proprietary software systems. Work Style: Self-motivated and comfortable thriving in a fully remote, camera-on environment with virtual supervision and support.

salary: $22.99 - $23 per hour
shift: First
work hours: 7 AM - 5 PM
education: High School

Responsibilities

Review, evaluate, and resolve provider disputes and reconsideration requests from healthcare facilities and providers.
Navigate internal case management systems to analyze claims and determine appropriate resolutions.
Modify and manage medical authorizations as needed.
Partner and communicate effectively with Utilization Management (UM) and claims departments.
Consistently meet established daily case-review productivity targets while maintaining a monthly quality average of 95% or higher.
Actively participate in a structured remote onboarding program to learn new processes, systems, and health plan specifics.

Skills

• Typing 40 wpm
• Claims/Coding
• appeals, authorizations

Qualifications

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

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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 click.appcast.io.

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.

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