Appeals Professional

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Appeals Professional based in the United States.

This role is focused on conducting detailed, evidence-based reviews of complex healthcare appeals and dispute cases within a federal program environment. You will serve as an independent decision-maker responsible for evaluating medical records, regulatory guidance, and policy documentation to determine the validity of appeals related to enrollment denials, suspensions, or revocations. The position requires strong analytical judgment, attention to detail, and the ability to interpret complex healthcare regulations with accuracy and fairness. You will be expected to produce clear, well-reasoned determinations that are fully supported by evidence and compliant with federal guidelines. Operating in a remote and structured environment, you will collaborate indirectly with providers, beneficiaries, and stakeholders while maintaining impartiality and consistency in decision-making. This is a highly responsible role suited for professionals who thrive in research-heavy, policy-driven healthcare settings.

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Appeals Professional based in the United States.

This role is focused on conducting detailed, evidence-based reviews of complex healthcare appeals and dispute cases within a federal program environment. You will serve as an independent decision-maker responsible for evaluating medical records, regulatory guidance, and policy documentation to determine the validity of appeals related to enrollment denials, suspensions, or revocations. The position requires strong analytical judgment, attention to detail, and the ability to interpret complex healthcare regulations with accuracy and fairness. You will be expected to produce clear, well-reasoned determinations that are fully supported by evidence and compliant with federal guidelines. Operating in a remote and structured environment, you will collaborate indirectly with providers, beneficiaries, and stakeholders while maintaining impartiality and consistency in decision-making. This is a highly responsible role suited for professionals who thrive in research-heavy, policy-driven healthcare settings.

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

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