Clinical Appeals Analyst

Piper Companies is recruiting a Clinical Appeals Analyst to support a prominent organization within the health insurance industry. This is a fully remote contract opportunity. The Clinical Appeals Analyst will assist with clinical review functions, coordinate the appeals process, and ensure adherence to regulatory requirements and medical‑necessity criteria.

Responsibilities of the Clinical Appeals Analyst

• Performing clinical reviews for member and provider appeals in compliance with state, federal, and accreditation standards.
• Serving as a clinical resource for non‑clinical appeals staff and collaborating with physicians and internal stakeholders.
• Reviewing and analyzing complex medical documentation, obtaining additional information as needed, and summarizing cases for final determination.
• Drafting written appeal determinations, initiating claim adjustments when appropriate, and meeting all required turnaround times.
• Identifying trends, risk areas, and process gaps, and recommending opportunities for education or corrective action.

Qualifications of the Clinical Appeals Analyst:

Qualified candidates will have:

• An active Registered Nurse (RN) license in their state of residence.
• At least three years of clinical experience for RN applicants.
• Experience working with Medicare and/or Medicare Advantage programs.
• Background in telephonic appeals, case management, or utilization management.
• Strong knowledge of medical policy interpretation, CMS guidelines, and regulatory standards.

Compensation of the Clinical Appeals Analyst:

• Salary Range: $69,000–$79,000 annually (USD)
• Benefits Package: Medical, dental, and vision coverage; sick leave where required by law; and a 401(k) plan.

 This position opens for applications on January 29, 2026, and applications will be accepted for a minimum of 30 days from the posting date.

 Keywords: Clinical appeals, RN, Medicare, Medicare Advantage, case management, utilization review, medical necessity, clinical documentation, insurance operations, grievance and appeals, CMS, NCQA, healthcare compliance, payer operations.

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