Health Care Claims Specialist
Claims SpecialistClaims SpecialistFull TimeRemoteSeniorTeam 1,001-5,000Since 1979H1B SponsorCompany SiteLinkedIn
Location
District of Columbia + 1 moreAll locations: District of Columbia, Washington
Posted
169 days ago
Salary
$78K - $119K / year
Seniority
Senior
Bachelor Degree5 yrs expExperience acceptedEnglish
Job Description
• Support attorneys by reviewing claim files, compiling factual summaries, and identifying key documents to facilitate legal analysis
• Identify liability, potential defenses, exposure valuations, and settlement strategies
• Review and analyze health care claim files involved in payor/provider disputes, identifying patterns and administrative issues such as coding errors, denial reasons, and medical necessity claims
• Evaluate merits and potential liability of claim batches to assess applicability to claims in dispute
• Review claim analysis and data from clients to validate findings, identify legal and factual issues, and support or challenge conclusions
• Maintain case summaries, claim trackers and databases ensuring accurate and timely communication with legal teams and clients
• Synthesize information into actionable summaries to support legal analysis and trial strategy
Job Requirements
- Familiarity with health care insurance claims
- Strong working knowledge of payer-provider contracts, Medicare/Medicaid rules and regulations, and claims reimbursement frameworks
- Experience reviewing and interpreting large volumes of healthcare claims data, EOBs, and denial codes
- Strong written communication skills and ability to produce clear, concise and structured claim summaries
- Excellent attention to detail, critical thinking and organizational skills
- Proficiency with MS Suite and data driven analysis tools including document management systems, claims platforms, or litigation databases preferred
- Ability to work collaboratively with attorneys and clients to provide support to litigation teams
- Bachelor’s degree or equivalent combination of education and experience
- Minimum of five (5) years of experience in health care claims analysis, insurance claims, payor-provider disputes, or litigation support with focus on managed care or regulatory compliance
- Prior experience at a law firm or insurance company handling health care litigation or audits
- Familiarity with CMS manuals, coverage determinations, and medical necessity standards
- Understanding of sampling and extrapolation methodologies
Benefits
- Competitive compensation and comprehensive benefits package
- Healthcare
- Vision
- Dental
- Retirement
- All-purpose leave
- Back up childcare
- Wellness programs
- Cultural events and social activities
- Discretionary bonus
- Remote work options
