Claims Specialist

Job Summary

The Clinical Review Coordinator will support the successful execution of clinical review and appeals projects by coordinating workflows, monitoring case activity, and collaborating with internal and external stakeholders. This individual will play a key role in managing provider and client communications, tracking deadlines and deliverables, and supporting interdisciplinary project operations in a fast-paced healthcare environment.

Key Responsibilities

• Serve as the primary point of contact for appeals and dispute adjudication programs
• Coordinate communication and documentation requests between healthcare plans, providers, patients, clients, and internal teams
• Monitor case statuses, updates, and correspondence through client portals and tracking systems
• Perform initial eligibility and case reviews, escalating recommendations to leadership as appropriate
• Assign and track cases using internal databases and project management software
• Distribute clinical documentation to coders, billers, nurses, physicians, and other stakeholders to support case reviews
• Monitor project timelines, quality standards, and contractual deadlines to ensure compliance and timely completion
• Identify workflow inefficiencies and recommend process improvements to enhance operations
• Present project and case updates during team huddles, scrums, and status meetings
• Schedule meetings, document action items, and track follow-up tasks and deliverables
• Prepare and submit billing invoices, while coordinating with finance and accounting teams regarding payment tracking
• Support onboarding, mentoring, and training of new team members on workflows and case management processes
• Assist with additional operational and administrative projects as needed

Qualifications

• Associates or Bachelors degree in Healthcare Administration, Business, Management, Digital Studies, or a related field
• Minimum 2 years of healthcare administration, claims processing, project coordination, or related experience preferred
• Strong organizational and multitasking abilities with attention to detail
• Experience working with collaborative project management tools and electronic documentation systems
• Excellent written and verbal communication skills, including professional phone etiquette
• Ability to work independently and collaboratively in a deadline-driven environment
• Strong problem-solving skills with the ability to adapt in a fast-paced setting

Preferred Qualifications

• Bachelors degree or advanced degree preferred
• Experience supporting collaborative healthcare or clinical review projects preferred, though recent graduates with relevant internship or project experience will also be considered

Schedule

• MondayFriday
• 8:00am5:30pm