Health Care Claims Specialist

Job not on LinkedIn

October 1

☕ Washington – Remote

Although this job is listed in Washington, this company may be open to hiring remote in other states.

💵 $78k - $119k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🔒 Insurance

🦅 H1B Visa Sponsor

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Crowell & Moring

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Crowell & Moring is an international law firm with operations in the United States, Europe, MENA, and Asia. Drawing on significant government, business, industry and legal experience, the firm helps clients capitalize on opportunities and provides creative solutions to complex litigation and arbitration, regulatory and policy, and corporate and transactional issues. The firm is consistently recognized for its commitment to pro bono service as well as its programs and initiatives to advance diversity, equity and inclusion.

1001 - 5000 employees

📋 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

🎯 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