Healthcare Administration Professional Needed

### Healthcare Claims Appeal Reviewer We are seeking an experienced healthcare administration professional to review U.S. health insurance appeal packets before submission. Applicants may be located worldwide, but direct experience with U.S. claims, denials, prior authorizations, or appeals is required. This is an ongoing, part-time contractor role supporting Remedy Support, a healthcare administrative advocacy service. Appeal drafts and supporting packets are prepared through a structured workflow and reviewed by a human specialist before submission. The reviewer is not expected to write appeals from scratch. The primary responsibility is to verify accuracy, completeness, consistency, evidence alignment, and procedural readiness. ### Responsibilities You will review appeal packets that may include: * Insurance denial letters * Explanations of Benefits * Medical records * Letters of medical necessity * Claim and authorization information * Carrier-specific appeal forms * Authorized representative documents * Draft appeal letters For each assigned case, you will: * Confirm that the appeal addresses the actual denial reason * Compare claim numbers, dates, CPT codes, provider information, and other identifiers across documents * Verify that statements in the appeal are supported by the uploaded records * Identify missing, contradictory, or irrelevant documentation * Confirm that required forms and authorizations are present * Check packet organization, completeness, and formatting * Approve packets that meet quality standards * Return incomplete or inaccurate packets with clear revision instructions * Record findings inside a secure browser-based case management system ### Required Experience Applicants must have direct experience with at least one of the following: * Health insurance claims review * Claims denials and appeals * Prior authorization review * Utilization review involving coverage decisions or denials * Denial management * Payer operations involving claims or appeals * Provider reimbursement disputes Related experience in medical billing, revenue cycle management, medical coding, or healthcare administration is valuable but should include meaningful exposure to claims, denials, authorization decisions, or appeal documentation. ### Preferred Qualifications Preference will be given to applicants with: * CPC, CPC-A, CCS, COCAS, or similar credentials * Experience with commercial health insurance appeals * Experience working with UnitedHealthcare, Aetna, Cigna, Humana, Anthem, or BCBS * Familiarity with CPT, HCPCS, ICD-10, claim identifiers, and authorization numbers * Strong attention to detail * Clear written communication * Experience identifying documentation gaps * Comfort reviewing AI-generated drafts without assuming they are correct ### Privacy and Data Handling This role involves access to sensitive healthcare information inside a controlled system. Reviewers must: * Work only inside the approved case management platform * Avoid downloading or storing customer information locally * Avoid screenshots or screen recordings * Avoid personal email or messaging systems * Avoid external AI tools or external document editors * Maintain confidentiality at all times * Follow all required privacy, security, and data-handling procedures Selected contractors will be required to sign confidentiality and data-handling agreements before receiving access. ### Work Structure * Ongoing, per-case assignments * Remote work * Flexible scheduling * Standard cases should generally be reviewed within 2 to 3 business days * Review volume will begin low during the soft-launch period and increase over time * Early cases will be subject to secondary quality review ### Compensation Ongoing assignments are paid at a fixed rate of ** $8 per completed case review **. Cases are prepared and organized before assignment. The reviewer’s role is focused on accuracy, completeness, evidence alignment, and limited corrections rather than writing appeals from scratch. ### Initial Assessment Shortlisted applicants will receive a synthetic test case containing sample appeal documents and intentionally inserted errors. The assessment will evaluate: * Accuracy * Evidence review * Identification of missing or contradictory information * Understanding of the denial reason * Quality of revision instructions * Ability to follow a structured review process No real patient information will be used during the assessment. ### To Apply Please include: * Your relevant healthcare experience * Any certifications you hold * The types of claims, denials, or appeals you have reviewed * The insurance carriers or plan types you have worked with * Your estimated weekly availability