Sr. Administrative Specialist – Medical Appeals

Job Title: Sr. Administrative Specialist - Medical AppealsJob OverviewWe are seeking a detail-oriented Sr. Administrative Specialist to support the Medical Appeals team. This role plays a critical part in the Independent Medical Review (IMR) process by analyzing clinical documentation, coordinating case information, and supporting healthcare providers, health plans, and patients. The ideal candidate will have experience in healthcare administration, strong analytical skills, and the ability to manage sensitive medical information with accuracy and professionalism.Key ResponsibilitiesMaintain thorough knowledge of medical appeals processes, IMR guidelines, and organizational policiesServe as a Subject Matter Expert (SME) in designated medical or appeals workflowsReview and analyze clinical documentation submitted for Independent Medical ReviewCollect, verify, and enter medical records and data from providers, facilities, labs, and health plansEnsure accuracy and completeness of patient case files in compliance with healthcare regulations (e.g., HIPAA)Respond to inbound inquiries from providers, health plans, and patients regarding case status and appeals processesCoordinate with internal clinical teams to ensure timely and accurate case processingSupport quality assurance efforts and identify opportunities to improve workflow efficiencyQualificationsAssociate degree with 2+ years of experience in healthcare administration, medical office, or insuranceORHigh School Diploma/GED with 4+ years of relevant healthcare experienceExperience reviewing medical records, insurance claims, or appeals preferredFamiliarity with medical terminology and clinical documentationStrong attention to detail and organizational skillsExcellent communication skills, both written and verbalAbility to manage high-volume caseloads in a fast-paced healthcare environmentAdditional DetailsPay Rate: $18.50/hourAssignment Length: 6 months to 1 yearSchedule: Monday - Friday, 8:30 AM - 5:00 PM (Pacific Time)Location Requirement: Candidates must reside in Mountain or Pacific time zones due to shift alignment#INDWEST