What are the responsibilities and job description for the Medical Case Manager (Insurance Claims & Appeals) position at Spin Hire?
Join a mission-driven health technology firm dedicated to securing insurance coverage for complex, high-value medical procedures. We operate at the high-stakes intersection of healthcare, insurance, and regulatory law, building rigorous advocacy strategies to challenge improper denials and help patients access life-changing care.
We are looking for a Medical Case Manager (Insurance Claims & Appeals) who will own the lifecycle of a patient’s case from onboarding to resolution. You are the "engine" of the advocacy process—keeping complex cases organized, ensuring no deadline is missed, and serving as the primary liaison between patients, providers, and insurers.
You will manage a dedicated caseload, coordinating with our internal team of appeal writers and strategists to ensure every case has the clinical and administrative evidence needed to win. We need you to be adaptable to change.
What You'll Do
- Case Ownership & Workflow Management
- Drive Progression: Proactively manage a portfolio of complex cases, ensuring steady movement through the insurance pipeline.
- Timeline Oversight: Monitor appeal deadlines, claim status, and authorization windows to prevent any gaps in advocacy.
- Documentation Excellence: Build and maintain organized case files meticulously, extracting key facts from insurance documents and medical records.
- Strategic Communication & Liaison
- Patient Advocacy: Act as the primary point of contact for patients, providing empathetic guidance and regular status updates during high-stress medical situations.
- Provider Coordination: Partner with physician offices and billing teams to gather missing clinical documentation and medical records.
- Insurer Persistence: Communicate directly with insurance adjusters and plan administrators to confirm claim status and push back on administrative delays.
- Appeal Preparation
- Case Synthesis: Assemble structured case packets for our internal strategy team, highlighting denial reasons and medical background.
- Issue Escalation: Identify potential bottlenecks (e.g., missing records or insurer stalling) early and escalate them to the advocacy team for intervention.
What Success Looks Like
- Zero Gaps: Cases move through the process without stalling due to missing documentation or missed follow-ups.
- Clarity: Patients feel supported and informed, even when the insurance process is opaque.
- Readiness: Internal strategists can focus on high-level legal/clinical arguments because the case files you provide are complete and organized.
What You Need
- High-Stakes Organization: Experience managing multiple complex projects with competing deadlines.
- Professional Persistence: A "polite but firm" approach to navigating bureaucracy and following up with insurers.
- Analytical Literacy: Ability to read and interpret complex insurance plans, medical records, and denial letters.
- Superior Communication: Composed and professional when speaking with patients, physicians, and attorneys.
- Bonus:
- We highly value candidates with experience in:
- Legal/Litigation Support: Personal injury or insurance defense paralegals.
- Revenue Cycle Management: Medical billing, coding, or claims analysis.
- Patient Advocacy: Navigating health insurance appeals or healthcare administration.
Salary & Perks
- Location: Irvine - Orange County, CA
- Competitive Salary performance-based bonuses tied to case management excellence.
- This is a full-time position.
- The position is immediately available.
- Hybrid role, 2-3 days remote, flexible work culture with zero corporate BS
- Bonus opportunities are dependent on performance
- Direct access to the founder and a seat at the strategic table
Ready to apply?
We'd love to hear your story. The next step is a short application where you can share more about your background and upload your resume. Take your time — we read every response carefully.