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Clinical Specialist (Remote)
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Role: Medical Specialist
Location: Remote (Work from Anywhere)
Job Type: Contract
Payout: $97 - $203/hour
Role Overview:
We are hiring for one of our clients, seeking a Medical Specialist to work on a contract basis. The role involves evaluating medical records, determining patient eligibility, and ensuring accurate claim processing. You will collaborate with healthcare providers and insurance teams to resolve complex medical cases.
Key Responsibilities:
- Evaluate medical documentation to assess patient eligibility for compensation or benefits.
- Analyze healthcare claims to identify discrepancies and ensure compliance with policies.
- Provide expert medical opinions to support claim decisions and appeals.
- Consult with legal and administrative teams to clarify medical findings and requirements.
- Maintain up-to-date knowledge of medical guidelines and regulatory changes affecting claims.
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Required Skills & Qualifications:
- Board certification in a medical specialty (e.g., Internal Medicine, Family Practice, Emergency Medicine).
- Minimum of 3 years of clinical experience in direct patient care or medical review.
- Experience with medical coding systems (e.g., ICD-10, CPT) and claim adjudication processes.
- Strong analytical skills to interpret medical records and synthesize complex information.
- Familiarity with healthcare compliance standards and insurance industry regulations.
- Excellent written and verbal communication to articulate medical findings clearly.
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More About the Opportunity:
This role offers a unique opportunity to work with a global leader in the Insurance industry, contributing to fair and accurate claim resolutions. The position provides exposure to high-volume medical evaluations across diverse specialties.
Equal Opportunity Employer:
We hire based on skills and expertise. All qualified candidates are welcome regardless of background, experience, or prior employment history. Applications are reviewed solely on demonstrated technical ability and qualifications.
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