<p><strong>Clinical Appeals Representative (Contract — Fully Remote)</strong></p><p>We’re seeking a detail-oriented <strong>Clinical Appeals Representative</strong> to join our team on a contract basis. In this role, you will support key health insurance operations by managing documentation, coordinating with providers, and ensuring appeals and grievances are processed accurately and on time. This is a fully remote opportunity to make a meaningful impact in the healthcare industry while working with a collaborative and mission-driven team.</p><p>W<strong>Key Responsibilities</strong></p><ul><li>Maintain accurate, organized, and up-to-date documentation within designated databases.</li><li>Coordinate with healthcare providers and external partners to obtain required medical records and supporting documentation.</li><li>Process appeals and grievances within established Health Plan timelines (24 hours to 10 days depending on request type).</li><li>Communicate clearly and professionally with all stakeholders to ensure transparency and resolution.</li><li>Support the team in reviewing and resolving complex appeals and grievances.</li><li>Monitor progress, identify bottlenecks, and escalate issues as needed to maintain regulatory compliance.</li><li>Adhere to company policies and procedures while handling confidential medical information.</li><li>Collaborate with team members to drive process improvements and enhance operational efficiency</li></ul>

<p><strong>Qualifications</strong></p><ul><li>Proven experience handling appeals or grievances within the healthcare or health insurance industry.</li><li>Strong documentation, organization, and data-entry skills with excellent attention to detail.</li><li>Familiarity with health plans, medical terminology, and healthcare grievance processes.</li><li>Knowledge of healthcare regulations and compliance standards.</li><li>Ability to manage multiple tasks, prioritize effectively, and consistently meet deadlines.</li><li>Exceptional written and verbal communication skills for interacting with providers and internal teams.</li><li>Comfortable working independently in a fully remote environment.</li></ul><p><br></p>

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