Appeals Specialist

Overview Handle the full lifecycle of member/provider appeals from intake and eligibility validation through analysis, decision-making, and closure. Review claims, medical/reimbursement policies, and contract terms to formulate appeal recommendations, and collaborate with coding specialists, nurses, and physician reviewers to reach timely decisions. Key Responsibilities Validate appeal intake (timeliness, benefits, employer group, provider contracts) and document in system. Analyze claims, policies, and documentation to build appeal recommendations. Issue non-clinical determinations per department guidelines; coordinate clinical reviews as needed. Manage external review coordination, documentation, and communication with all parties. Track appeals and support reporting on trends, volume, and compliance. Serve as a courteous, professional point of contact for members/providers throughout the appeal process. Top Skills Call Center, Customer Service, Data Entry, Computer Skills Requirements High school diploma/GED + 4 years' experience in customer service, claims, or clinical services (or equivalent combo of education/experience). Intermediate MS Office skills (Word, Excel, Outlook). Knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs) preferred. Strong written/verbal communication, analytical, and multitasking skills. Coding certification a plus. Job Type & Location This is a Contract to Hire position based out of Lewiston, ID. Pay and Benefits The pay range for this position is $23.00 - $28.00/hr. Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave) Job Type & Location This is a Contract to Hire position based out of Lewiston, ID. Application Deadline This position is anticipated to close on Oct 28, 2026. Workplace Type This is a fully remote position. About TEKsystems We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services Were a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. Were a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. Were strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. Were building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records. Massachusetts Lie Detector: 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. Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools. #J-18808-Ljbffr TEKsystems