<p>Are you looking for a rewarding remote role in healthcare administration? This <strong>Clinical Appeals Representative</strong> position offers the opportunity to make a meaningful impact while working from the comfort of your home. As a <strong>Clinical Appeals Representative</strong>, you will play a key role in managing the intake and processing of grievances and potential quality of care issues on behalf of Health Plan members. This full-time role runs Monday through Friday, 0800–1630, with training held during the same hours. Interviews will be conducted via Microsoft Teams.</p><p><br></p><p>Responsibilities:</p><ul><li>Serve as the primary point of contact for Health Plan member grievances and internally identified potential quality of care issues (PQI).</li><li>Coordinate the receipt and initial processing of grievances, including data entry, medical record requests, and follow-up activities.</li><li>Maintain accurate and timely documentation in relevant databases.</li><li>Communicate and coordinate with provider offices and other stakeholders to ensure required documentation is obtained within specified timelines (ranging from 24 hours to 10 days).</li><li>Monitor and manage turnaround times (TATs) in accordance with Health Plan requirements.</li><li>Ensure quality and compliance standards are met throughout the appeals process.</li></ul>

<p>Job Requirements:</p><ul><li>High School diploma or GED equivalent required.</li><li>Experience in healthcare administration, quality assurance, or related fields is preferred.</li><li>Strong organizational and time management skills with the ability to handle multiple priorities.</li><li>Proficient in data entry and database management.</li><li>Excellent written and verbal communication skills.</li><li>Must be located onshore (within the United States).</li><li>Reliable internet connection and a quiet, professional remote workspace.</li></ul>

<h3 class="rh-display-3--rich-text">TalentMatch^®</h3> <p>Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.</p> <p>Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. <a href="https://www.roberthalf.com/us/en/mobile-app" target="_blank">Download the Robert Half app</a> and get 1-tap apply, notifications of AI-matched jobs, and much more.</p> <p>All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit <a href="https://roberthalf.gobenefits.net/" target="_blank">roberthalf.gobenefits.net</a> for more information.</p> <p>© 2025 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to <a href="https://www.roberthalf.com/us/en/terms">Robert Half’s Terms of Use</a>.</p>