Appeals Specialist II

Job Title: Appeals Specialist – Entry Level

Location: Remote (EST/CST hours)

Schedule: Monday–Friday, 8 AM–6 PM EST (training 9 AM–6 PM EST, no time off during training)

Duration: 6 months (possibility to extend or convert)

Experience Level: Entry Level

Position Purpose

Supports the documentation and processing of appeals, disputes, and reconsiderations to ensure compliance with state and NCQA requirements. This role ensures timely review, accurate routing, and proper case resolution while maintaining strict adherence to company policies and standards.

Key Responsibilities

• Perform data entry to track, log, and process appeals, disputes, and reconsiderations in accordance with regulatory and accreditation guidelines.
• Prepare correspondence and maintain documentation files for appeals and disputes.
• Review and investigate appeals, disputes, and reconsideration requests to determine appropriate follow-up actions.
• Conduct research to evaluate and respond to appeals, ensuring timely decisions.
• Prepare case files with supporting documentation and determinations for review and reporting.
• Gather data to track and report on trends and outcomes, including outreach for status updates and determinations.
• Collaborate cross-functionally to ensure accuracy, efficiency, and compliance in case handling.
• Comply with all company policies, standards, and quality requirements.

Qualifications

• Education: High school diploma or GED required.
• Experience: 1–2 years of claim processing, prior authorizations, or utilization management experience.
• Disqualifiers: Lack of claims/authorization experience, unrelated recent roles, or excessive job hopping.

Job Type & Location

This is a Contract to Hire position based out of Troy, MI.

The pay range for this position is $23.00 - $23.00/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)

This is a fully remote position.

This position is anticipated to close on Mar 20, 2026.

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.