Insurance Appeals Specialist

Overview

This is a Full-Time, Remote role (eligible in U.S. jurisdictions with an established office). The position involves managing, researching, interpreting, and drafting timely and Billing Guideline-compliant responses to insurance company deductions taken on defense counsel invoices.

This role reports to the EPLI Project Manager.

Responsibilities

Oversight of EPLI Appeals

• Develop a thorough understanding of each insurance company’s Defense Counsel Billing Guidelines.
• Review, assess, and research insurance billing deductions using matter files and the Defense Counsel Billing Guidelines to determine appealability.
• Draft persuasive, compliant, and well-written responses to each reduction.
• Communicate professionally and proactively with impacted timekeepers regarding reduced entries that need additional detail not obtainable from the matter file.
• Partner with the Billing and Collections team to submit appeal responses to insurance companies in a timely manner.
• Develop and implement strategies to improve Guidelines-compliant entries and reduce reductions.
• Monitor outcomes of submitted appeals to strengthen and improve subsequent responses.

Operational Strategy & Reporting

• Work with the Director of Legal Project Management and the EPLI Project Manager to establish financial and other performance goals.
• Track outcomes of submitted appeals, including the amount credited versus appealed and the number of successfully appealed time entries.
• Provide reports to leadership regarding appeal results, staffing needs, and other information as needed.

Interdepartmental Collaboration

• Collaborate with Legal Project Management, Knowledge Management, Billing and Collections, and Information Technology to implement AI or other technology solutions that create efficiencies or improve outcomes.

Requirements

Required

• Bachelor’s degree and at least 5 years of experience in legal bill review or insurance defense work, including prior experience as an attorney or paralegal at a large law firm or major insurance company.
• Deep understanding of defense counsel activities, legal terminology, and insurance company Defense Counsel Billing Guidelines.
• Proficiency in legal billing software (BillBlast, Aderant), eBilling vendors (Legal Tracker, Tymetrix 360), and Microsoft Office applications (Word, Outlook, PowerPoint, Excel).
• Exceptional written, verbal, and interpersonal communication skills with a proven ability to build effective working relationships with internal and external personnel at all levels.
• Superior judgment, discretion, and commitment to handling sensitive and confidential matters professionally.
• Highly organized with the ability to manage multiple projects, prioritize assignments, and work independently and collaboratively.
• Ability and willingness to travel to firm offices and other events as needed.

Preferred

• Juris Doctor (JD) degree.
• Specific experience defending labor and employment matters.
• Familiarity with the operational structure of large, multi-office litigation law firms.
• Demonstrated commitment to diversity, equity, and inclusion in legal staffing.

Compensation & Benefits

Compensation

• Hourly range: $48.08 - $57.69.
• Actual base pay within this range will be determined by factors including location, relevant experience, internal equity, skills, qualifications, and other job-related factors permitted by law.

Benefits

• Health, dental, and vision insurance
• 401(k) with profit sharing
• 18 days of vacation
• Accrue 10 sick days each calendar year and 10 paid holidays per benefit year
• Wellness programs and 24/7 telehealth services

Location

• Fully remote from any location within the United States where the employer currently maintains an established office.

Additional Notes

• Statements in the position description are not necessarily all-inclusive; additional duties and responsibilities may be assigned.
• Qualified applications with arrest or conviction records will be considered in accordance with applicable law.
• Relocation costs are not covered.
• Direct applicants only; third-party recruiters or agencies will not be considered.
• No phone inquiries.