Healthcare Appeals & Case Coordinator - EST Hours

ISTA Personnel Solutions South Africa, a dynamic and fast-growing BPO company, is seeking a highly organized, resilient, and detail-driven Healthcare Appeals & Case Coordinator to support one of our established U.S.-based healthcare clients.

This position is suited to a candidate with strong prior experience in medical case coordination, insurance communication, appeals handling, provider follow-up, and high-volume healthcare administration.

This is a demanding, deadline-driven role requiring someone who can confidently manage a heavy caseload, navigate U.S. insurance processes, handle constant communication, and multitask across calls, documentation, emails, and follow-ups simultaneously.

This is a high-volume healthcare operations role requiring a candidate who is comfortable managing multiple moving parts simultaneously, including patient cases, insurance calls, provider follow-up, documentation, and large email volumes. Candidates with only front-desk, scheduling, or low-volume medical admin experience will not be suitable.

PLEASE NOTE:

• Working Hours: This role requires you to work USA hours Mon - Fri from 9 am to 6 pm EST (3:00pm to 00:00am South African time); however, these hours are subject to change depending on daylight savings.
• Internet Requirements: A fixed fibre line with a minimum speed of 25 Mbps (upload & download) and the ability to support a wired Ethernet connection is mandatory. Applicants without a fixed fibre line cannot be considered.
• Power Backup: A reliable power backup solution is required to manage load shedding and power outages. Applicants without a power backup cannot be considered.
• Work Environment: This is a fully remote working role.
• Public Holidays: You will be required to work on all South African public holidays (compensated as per BCEA).

Key Responsibilities:

• Manage approximately 15+ active patient cases per day with speed, urgency, and accuracy
• Coordinate all patient case documentation, status updates, and follow-up actions
• Draft, submit, and monitor medical appeals and insurance-related supporting documentation
• Process NOMNCs and similar patient insurance notices
• Conduct regular inbound and outbound communication with insurance providers
• Remain productive while managing long payer hold times and simultaneous administrative tasks
• Perform provider follow-ups regarding authorizations, documentation, and care updates
• Manage a high-volume inbox of approximately 100–150 emails daily
• Maintain accurate patient notes, file updates, and case progression records in real time
• Escalate urgent denials, delays, and unresolved payer issues appropriately
• Ensure strict turnaround times are met in a deadline-sensitive environment

Requirements:

• Minimum 3 years’ experience in healthcare case coordination, medical insurance communication, managed care, appeals, authorizations, or similar healthcare support roles
• Proven experience handling high patient/case volumes in a fast-paced environment
• Strong multitasking ability across calls, emails, systems, and documentation simultaneously
• Excellent written and verbal English communication
• Highly computer literate with the ability to quickly learn client systems and processes
• Strong attention to detail and urgency in follow-up
• Able to work independently and remain calm under pressure

Advantageous:

• Prior clinical or patient-care exposure
• Previous experience supporting U.S. or international healthcare teams

If you are not contacted within 14 working days, please consider your application unsuccessful.