Healthcare Appeals & Case Coordinator - EST Hours (Remote)

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.

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ISTA Solutions is home to rockstar professionals who aim to be engaged in defining and building an employee centric culture, focused on long term success, work-life balance, and life-long learnings. From the industries we support, to the functions we perform, ISTA has structured ourselves differently from other outsourcing companies; effectively setting ourselves apart from the rest of the pack. If you are looking for something new and something different, where you are engaged not only in your own success but in defining and building the culture you want to belong in, you've come to the right place.