Workers' Compensation Appeal Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Workers' Compensation Appeal Specialist based in United States.

As a Workers' Compensation Appeal Specialist, you will play an important role in resolving post-payment medical billing disputes and supporting effective healthcare cost containment.

You will manage a caseload of Workers' Compensation bills, including balance billing and usual-and-customary-rate disputes.

The role combines provider outreach, payment negotiation, regulatory compliance, and detailed case documentation.

You will work directly with healthcare providers and internal clients to investigate appeals and reach appropriate resolutions.

Your expertise will help ensure accurate reimbursement while maintaining compliance with state-specific requirements and HIPAA standards.

This is an opportunity to contribute to a collaborative, detail-oriented environment where communication, judgment, and organization are highly valued.

The ideal candidate is confident handling negotiations, comfortable navigating complex billing matters, and committed to delivering timely, high-quality outcomes.

Accountabilities:

• Manage an assigned caseload of post-payment Workers' Compensation bills, including state balance-billing matters and usual-and-customary-rate (UCR) disputes.
• Conduct proactive outreach to medical providers to explain payment methodologies, investigate disputed charges, and negotiate reductions on appealed or outlier bills.
• Communicate professionally with clients to gather information, coordinate investigations, and support effective appeal resolution.
• Educate providers on Workers' Compensation billing practices, reimbursement methodologies, applicable policies, and regulatory requirements.
• Thoroughly document all provider interactions, including contact details, bill information, proposed and counter-offered payment rates, and final outcomes.
• Ensure all case activities comply with state-specific Workers' Compensation regulations, confidentiality standards, and HIPAA requirements.
• Maintain productivity and quality standards while resolving cases within applicable regulatory and client-specific timelines.
• Follow established client protocols, internal procedures, communication scripts, and documentation requirements.
• Monitor changes to Workers' Compensation regulations, fee schedules, reimbursement policies, and state-specific requirements across multiple jurisdictions.
• Collaborate effectively with internal team members and contribute to a positive, results-oriented team environment.
• Support special projects and take on additional responsibilities as needed.

Requirements:

• 2-3 years of relevant experience working with Workers' Compensation bills, medical billing, medical coding, insurance negotiations, or a closely related field.
• Strong understanding of Workers' Compensation reimbursement methodologies, state regulations, fee schedules, and provider billing practices.
• Demonstrated experience negotiating medical bill payments, adjustments, reductions, or disputed charges with healthcare providers.
• Familiarity with claims processing systems and provider-facing communications.
• Strong verbal and written communication skills, with the ability to explain complex billing and reimbursement matters clearly and professionally.
• Excellent negotiation, organization, prioritization, and case-management skills.
• Strong attention to detail and the ability to maintain accurate documentation across multiple cases.
• Sound judgment and decision-making skills, with the ability to evaluate information and determine appropriate next steps.
• Ability to collaborate effectively with a variety of internal and external stakeholders.
• High level of discretion, professionalism, and ethical conduct when handling confidential healthcare and claims information.
• Comfortable working in a structured, deadline-driven environment while maintaining productivity and quality standards.
• Strong technical aptitude and the ability to learn and navigate claims, billing, and other business systems.

Benefits:

• Salary: $55,000-$65,000 USD annually, with compensation based on experience and qualifications.
• Certain positions may offer additional compensation opportunities, including bonuses and merit increases.
• Comprehensive medical, dental, vision, and life insurance coverage.
• 401(k) retirement plan with employer matching.
• Health Savings Account (HSA) and Flexible Spending Accounts (FSAs).
• Paid time off (PTO) and disability leave.
• Employee Assistance Program (EAP) providing additional support and resources.
• Inclusive workplace committed to equal employment opportunity and respect for diverse backgrounds and perspectives.