[Remote] Appeals Specialist

Note: The job is a remote job and is open to candidates in USA. Point C is a National third-party administrator (TPA) that delivers customized self-funded benefit programs. They are seeking a detail-oriented Appeals Specialist to review, research, and resolve healthcare claim appeals for accuracy and compliance with regulations and internal procedures. Responsibilities Review incoming appeals to determine appropriate handling and next steps Analyze claim determinations, plan documents, and supporting documentation to ensure decisions are accurate and compliant Draft professional, well-supported appeal determinations and correspondence Collaborate with internal teams (claims, eligibility, customer service, and provider relations) to gather information and resolve cases Track and document all appeal activity in internal systems with accuracy and clarity Identify patterns or process issues contributing to appeal volume and communicate findings to leadership Support continuous improvement by suggesting updates to policies, templates, or workflows Maintain confidentiality and compliance with HIPAA and company policies Skills Strong attention to detail and organizational skills 1–2 years of experience in a healthcare or insurance environment 1-2 years of experience working with appeals Excellent written and verbal communication skills Ability to analyze data and documentation logically and objectively Experience reviewing and interpreting plan documents Comfortable managing multiple priorities in a fast-paced environment Proficiency in Microsoft Office (especially Excel and Outlook) Eagerness to learn the healthcare and TPA industry from the ground up Experience with medical, dental, or vision claim processing Prior work at a TPA, health plan, or provider office Familiarity with ERISA, state appeal timelines, or standard healthcare terminology (EOBs, CPT/ICD codes, etc.) Familiarity with the No Surprises Act Familiarity with CMS terminology Exposure to claim systems or workflow platforms Benefits Comprehensive medical, dental, vision, and life insurance coverage 401(k) retirement plan with employer match Health Savings Account (HSA) & Flexible Spending Accounts (FSAs) Paid time off (PTO) and disability leave Employee Assistance Program (EAP) Company Overview Point C is a network of self-insured healthcare plan third-party administrators. It was founded in 2020, and is headquartered in Chicago, Illinois, USA, with a workforce of 501-1000 employees. Its website is