We are looking for a detail-oriented Clinical Appeals Reviewer to join our team in Ontario, California. In this role, you will be responsible for coordinating and managing documentation related to clinical appeals, ensuring compliance with health plan timelines. This is a long-term contract position offering an excellent opportunity to contribute to the health insurance industry. 90% remote. May require the odd trip to the office to process mail. Responsibilities:• Maintain accurate and up-to-date documentation in designated databases to support appeals processes.• Coordinate with provider offices and other stakeholders to ensure timely submission and receipt of required documentation.• Manage turnaround times in accordance with health plan requirements, ranging from 24 hours to 10 days based on the type of request.• Communicate effectively with involved parties to resolve issues and ensure smooth processing of appeals.• Process incoming mail on-site as needed to support administrative workflows.• Adhere to established quality and compliance standards throughout all activities.• Utilize database systems to track and monitor appeal statuses and outcomes.• Collaborate with shared services and offshore teams to maintain operational efficiency.• Support training initiatives to ensure consistent understanding of processes and requirements.• Contribute to the continuous improvement of documentation and appeals handling procedures.

• Proven experience in data entry and documentation management. • Familiarity with health plan procedures, including appeals and compliance timelines. • Strong organizational skills with the ability to manage multiple tasks and deadlines. • Proficiency in using database systems for tracking and reporting purposes. • Excellent communication skills for interacting with provider offices and other entities. • Knowledge of clinical trial operations or related healthcare processes is a plus. • Ability to work both independently and collaboratively within a team setting. • Flexibility to occasionally work on-site for mail processing and other administrative tasks.

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Ontario, CA
remote
Temporary
23.00 - 24.00 USD / Hourly
We are looking for a detail-oriented Clinical Appeals Reviewer to join our team in Ontario, California. In this role, you will be responsible for coordinating and managing documentation related to clinical appeals, ensuring compliance with health plan timelines. This is a long-term contract position offering an excellent opportunity to contribute to the health insurance industry. 90% remote. May require the odd trip to the office to process mail. Responsibilities:• Maintain accurate and up-to-date documentation in designated databases to support appeals processes.• Coordinate with provider offices and other stakeholders to ensure timely submission and receipt of required documentation.• Manage turnaround times in accordance with health plan requirements, ranging from 24 hours to 10 days based on the type of request.• Communicate effectively with involved parties to resolve issues and ensure smooth processing of appeals.• Process incoming mail on-site as needed to support administrative workflows.• Adhere to established quality and compliance standards throughout all activities.• Utilize database systems to track and monitor appeal statuses and outcomes.• Collaborate with shared services and offshore teams to maintain operational efficiency.• Support training initiatives to ensure consistent understanding of processes and requirements.• Contribute to the continuous improvement of documentation and appeals handling procedures.
2025-10-06T18:48:44Z

Clinical Appeals Reviewer Job in Ontario | Robert Half