Denials Specialist

Contract Type / Duration: Contract 12 Months

Location: Fully Remote

Remote (preferred states): Missouri, Texas, Florida, Minnesota, Illinois, Georgia, South Carolina, North Carolina, Arizona, Michigan, California, Pennsylvania, Kentucky, Ohio, Oklahoma, New York, Maryland

Work Hours:

• Thursday, Friday, and Monday: 1:00 PM 10:00 PM EST

• Saturday and Sunday: 10:00 AM 6:30 PM EST

• Rotating holiday coverage required

Pay Rate:$23/hour

We are seeking a Denial Specialist II to generate, process, and maintain provider and member correspondence for pre-service and concurrent medical reviews. This fully remote role supports utilization management by ensuring denial and approval letters are completed accurately, on time, and in compliance with regulatory requirements.

The ideal candidate is detail-oriented, thrives in a fast-paced environment, and is comfortable managing multiple priorities while working independently.

1. Strong multitasking and organizational skills

2. Ability to adapt quickly to changing priorities

3. Excellent attention to detail with proficiency in Microsoft Excel, Outlook, Word, Teams, and OneNote

• Generate provider and member correspondence based on medical review documentation.

• Process denial and approval letters accurately and within required turnaround times.

• Maintain and update correspondence templates to meet regulatory and business requirements.

• Coordinate data collection, tracking, and reporting related to the denial process.

• Monitor compliance with correspondence turnaround time (TAT) requirements.

• Prioritize pending denial letters, escalations, and compliance deadlines.

• Review policy updates and internal communications impacting correspondence.

• Perform additional duties as assigned.

• Experience with healthcare denial management or utilization management

• Knowledge of medical terminology and medical record documentation

• Familiarity with claims, correspondence, or appeals management systems

• Experience working in a healthcare or managed care environment

• High School Diploma or GED required

• 1 2 years of related healthcare or administrative experience required

No certifications required.

• After training, process approximately:

  • 4 denial letters per hour, or

  • 6 7 approval letters per hour

• Maintain accuracy, productivity, and compliance while working independently in a remote environment.

• Candidate must be eligible for W-2 employment.

• No Corp-to-Corp (C2C) arrangements.

• Must be legally authorized to work in the U.S. without current or future sponsorship.

• Must be available to work the required schedule, including rotating holidays.

• Typing speed of 60 WPM with 95% accuracy is required.

• Basic computer proficiency in Microsoft Excel, Outlook, Word, Teams, and OneNote is required.

The client is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex (including pregnancy and gender identity), national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, military service, or any other protected status.