Job Title: Claims Appeals Specialist
Location: Offsite 

Type: 2+ month Contract
Compensation: $30/HR
Contractor Work Model: Remote


ALTA IT Services is seeking an experienced Appeals Specialist II to support one of our leading health insurance clients. The Appeals Specialist II is responsible for the intake, review, and initial analysis of appeals and grievances across Government Program lines of business. This role involves independent handling of complex and escalated cases, coordination of case documentation, and direct interaction with internal and external stakeholders.

Pay: $30/HR
100% Remote
Must have Guiding Care and A&G experience

Key Responsibilities: Research contractual benefits, limitations, exclusions, and claim details to support clinical staff in the review of appeals and grievances. Prioritize and analyze complex and escalated appeals and reconsideration requests, ensuring timely and accurate data entry. Perform administrative duties related to file management, including organization, purging, and coordination for off-site storage. Draft and support professional written and verbal responses to appeals in accordance with State and Federal requirements. Assist with vendor audit activities and special projects, and help resolve problematic cases. Collaborate with Appeals Nurses and Management to support case analysis and process improvements. Communicate effectively with internal departments and external stakeholders while protecting the confidentiality of medical information. Participate in meetings to improve quality, appeal research, and intake processes. Required Qualifications: 2+ years of experience in healthcare appeals, claims, or grievance resolution. Strong knowledge of Medicaid/Medicare or other Government Program regulations. Proficient in reading and interpreting medical documentation and insurance policies. Excellent verbal and written communication skills. Detail-oriented with strong organizational and analytical skills. Experience using health plan systems for appeals intake and tracking (e.g., Facets, QNXT, etc. preferred). Work Style & Supervision: Operates as an individual contributor under general supervision. Manages tasks independently with guidance for more complex issues. Interacts primarily with internal teams and occasionally with external parties on routine matters.



System One, and its subsidiaries including Joulé, ALTA IT Services, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

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Ref: #850-Rockville (ALTA IT)

System One, and its subsidiaries including Joulé, ALTA IT Services, TeamPeople, and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.