Health Care Claims Specialist

Crowell & Moring; Washington (District of Columbia); Hybrid; USD 78,000 - 119,000; Full time

Job summary

A leading international law firm is seeking a Health Care Claims Analyst to support attorneys with health care claims disputes. The role involves reviewing claims, identifying patterns, and providing analytical support on liability and settlement strategies. Qualified candidates should have a bachelor's degree and at least five years of relevant experience in health care claims analysis or litigation support. The position offers the flexibility of remote work and a competitive salary package.

Benefits

Healthcare benefits

Vision and dental insurance

Retirement plan

All-purpose leave

Wellness programs

Cultural and social activities

Qualifications

• Familiarity with health care insurance claims and payer-provider contracts.
• Experience in health care claims analysis or litigation support.
• Ability to produce clear and concise claim summaries.

Responsibilities

• Review and analyze health care claim files involved in disputes.
• Evaluate merits and potential liability of claims.
• Synthesize information into actionable summaries for legal analysis.

Skills

Knowledge of health care insurance claims

Reviewing large volumes of healthcare claims data

Strong written communication skills

Attention to detail

Proficiency with MS Suite

Collaborative work with legal teams

Education

Bachelor's degree

Tools

Document management systems

Claims platforms

Litigation databases

Job description

Overview

Crowell & Moring LLP is an international law firm with offices in the United States, Europe, MENA, and Asia that represents clients in litigation and arbitration, regulatory and policy, intellectual property, and transactional and corporate matters. The firm is internationally recognized for its representation of Fortune 500 companies in high-stakes litigation and government-facing matters, as well as its ongoing commitment to pro bono service and diversity, equity, and inclusion.

Job Summary

The Health Care Claims Analyst role will support attorneys by reviewing claim files, compiling factual summaries, identifying key documents and facilitating legal analysis regarding liability, potential defenses, exposure valuations, and settlement strategies.

This role can be fully remote or based in any Crowell office location.

Job Responsibilities

• 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.

Qualifications

Knowledge, Skills and Abilities

• Familiarity with health care insurance claims and 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

Education

• The position requires a bachelor’s degree or equivalent combination of education and experience.

Experience

• The position requires a 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, or related field.
• 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

Additional Information

Crowell & Moring LLP offers a competitive compensation and comprehensive benefits package. Our benefits include healthcare, vision, dental, retirement, and all-purpose leave and progressive options such as back up childcare, wellness programs, cultural events and social activities. We take great pride in our positive, friendly culture that rewards hard work and success, at the same time recognizing the importance of family and community service.

Our Firm is committed to fair and equitable compensation practice in accordance with applicable laws. The salary range for this position is $78,000-$119,000. Additional compensation may include a discretionary bonus. The salary for this position may vary based on location, market data, an applicant’s skills and prior experience, certain degrees and certifications, and other factors.

EOE m/f/d/v
Crowell & Moring LLP participates in the E-Verify program.