Clinical Appeals Representative

Clinical Appeals Representative (Contract — Fully Remote)

We’re seeking a detail-oriented Clinical Appeals Representative 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.

WKey Responsibilities

• Maintain accurate, organized, and up-to-date documentation within designated databases.
• Coordinate with healthcare providers and external partners to obtain required medical records and supporting documentation.
• Process appeals and grievances within established Health Plan timelines (24 hours to 10 days depending on request type).
• Communicate clearly and professionally with all stakeholders to ensure transparency and resolution.
• Support the team in reviewing and resolving complex appeals and grievances.
• Monitor progress, identify bottlenecks, and escalate issues as needed to maintain regulatory compliance.
• Adhere to company policies and procedures while handling confidential medical information.
• Collaborate with team members to drive process improvements and enhance operational efficiency
  

Qualifications

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

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.

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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 roberthalf.gobenefits.net for more information.

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