Professional Summary: The Appeals Specialist I is responsible for managing provider billing disputes and appeals with precision and professionalism. This role involves analyzing prior determinations, coordinating clinical reviews, and ensuring decisions align with subscriber/provider contracts, regulatory requirements, and internal policies. While not responsible for making final clinical decisions, the Appeals Specialist I works closely with licensed health professionals to support accurate and timely resolution of appeals. The ideal candidate brings strong analytical skills, healthcare knowledge, and the ability to communicate complex information clearly and diplomatically. Key Responsibilities: + Review and process provider billing disputes and appeals in accordance with contracts, regulatory mandates, and internal policies. + Analyze prior determinations and coordinate clinical reviews with licensed health professionals when necessary. + Make informed decisions on appeals and ensure timely and accurate notifications to stakeholders. + Provide clear and professional communication to members, providers, attorneys, and other external parties regarding benefits, claims, and eligibility. + Maintain detailed documentation of appeal activities and decisions in compliance with company standards. + Present complex medical and reimbursement information in a clear and persuasive manner. + Collaborate with internal departments to resolve issues and ensure consistency in appeal handling. + Utilize healthcare systems and tools (e.g., EMR, claims platforms) to research and support appeal decisions. + Demonstrate initiative in identifying problems, researching solutions, and implementing effective actions. Qualifications: + High school diploma or GED required. + Minimum of 4 years’ experience in customer service, claims, or clinical services within a healthcare or insurance setting. + Intermediate proficiency in Microsoft Word, Excel, and Outlook. + Strong knowledge of medical terminology, anatomy, and coding (CPT, DX, HCPCs). + Familiarity with Regence claims processing and clinical services operations. + Proven analytical and problem-solving skills. + Ability to communicate complex information diplomatically and effectively. + Coding certification (e.g., CPC from AAPC) preferred. + Prior experience in a provider’s office or health insurance environment is a plus. + Must reside in Oregon, Washington, Idaho, or Utah. Pay and Benefits The pay range for this position is $24.00 - $30.00/hr. 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) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Sep 13, 2025. h4>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 We’re 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. We’re 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. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re 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.