Healthcare Appeals Associate

Summary

Join a mission-driven health technology startup as a Healthcare Appeals Associate to help transform the healthcare system. You will work directly with the founder to draft persuasive insurance appeals, synthesize medical/legal data, and advocate for patients. This ground-level opportunity allows you to shape the future of insurance advocacy. You will utilize advanced legal, clinical, and technical vocabulary, research medical studies and insurance contracts, and interpret health insurance policies. The role involves working with coding systems, using AI tools, and maintaining CRM records. Your contributions will directly influence operational scaling and impact patients' lives.

Requirements

• Bachelor’s degree required
• Experience in one or more of the following: Health insurance appeals or prior authorization
• Experience in one or more of the following: Medical-legal research or health policy
• Experience in one or more of the following: Patient advocacy or nonprofit healthcare work
• Experience in one or more of the following: Utilization management or case review
• A stellar writer who can explain complex ideas clearly and persuasively
• Deeply curious, comfortable researching clinical literature and payer rules
• Empathetic and driven by impact — you care about changing lives
• Exceptionally detail-oriented and able to manage multiple cases and deadlines
• Comfortable working remotely, independently, and using digital tools

Responsibilities

• Draft insurance appeals using advanced legal, clinical, and technical vocabulary
• Research medical studies, insurance contracts (EOC/COC), court decisions, federal/state laws, and coverage guidelines to support each case
• Interpret health insurance policies and apply knowledge of covered benefits, medical necessity, and network exception laws
• Work with CPT/ICD-10/HCPCS coding systems to build the strongest possible clinical arguments
• Use generative AI tools as a co-pilot to accelerate drafting and increase effectiveness, but not as a primary method of document creation
• Call insurers and providers to verify authorization statuses and move the case forward
• Maintain CRM case records and documentation, keeping everything organized and up to date
• Help build a better system. Your ideas will directly influence how we scale operations and impact lives
• Create and maintain SOPs, templates, and internal documentation for appeals and workflows
• Guide patients through the appeal journey with clarity and empathy via email or phone
• Advocate with heart. Every letter you write may help someone get life-changing (or even life-saving!) surgery they couldn’t afford otherwise – your work is guaranteed to help change people's lives

Preferred Qualifications

• Preferred fields include law, public health, medicine, biology, journalism, or policy
• Bonus if you’ve worked with: CPT/ICD-10 codes, AI writing tools, CRM platforms, or medical documentation

Benefits

• Competitive Salary
• This is a full-time, long-term position
• Work from home
• Monday through Friday, 8 am to 5 pm (+/- 1 hour accepted) - PST
• Additional perks