Insurance Appeals Specialist

Insurance Appeals Specialist

(Full-time, Remote)

Fisher Phillips, a premier international labor and employment law firm, is seeking an Insurance Appeals Specialist to join our Legal Project Management Team or Billing and Collections Team. This role is responsible for managing, researching, interpreting, and drafting timely and Billing Guideline-compliant responses to deductions taken by insurance companies on defense counsel invoices.

The successful candidate will have experience with employment law, legal bill review, a strong understanding of insurance Defense Counsel Billing Guidelines, and the ability to professionally communicate with attorneys to develop strong working relationships and credibility with firm management, leaders, attorneys, and administrative departments across the firm.

This position can be performed on a fully remote basis and reports to the EPLI Project Manager or Billing Manager.

Key Responsibilities

Working primarily with the Director of Legal Project Management, EPLI Project Manager, and Billing and Collections Team, this individual will manage the process for reviewing, researching, and preparing timely and successful appeal responses including, but not limited to, the following responsibilities:

Oversight of EPLI Appeals

• Develop a thorough understanding of each insurance company’s Defense Counsel Billing Guidelines
• Review deductions taken from time entries on defense counsel bills and the reasoning or Guideline referenced as the reduction basis
• Apply legal and experiential knowledge to assess what reductions are appealable, and determine the best approach to a Guideline-compliant and successful response
• Research and analyze the matter file to identify what missing detail, explanation, context, or other information needed to draft a response that best supports the time billed
• Draft a persuasive, compliant, and well-written response to each reduction
• Communicate professionally, effectively, and proactively with impacted timekeepers regarding reduced entries that need additional detail that could not be obtained from the matter file
• Partner with the Billing and Collections team to timely submit the appeals responses to the insurance companies
• Develop and implement strategies to improve Guidelines-compliant entries and reduce reductions
• Monitor the outcomes of submitted appeals to fortify and improve subsequent draft responses

Operational Strategy & Reporting

• Work with the Director of Legal Project Management and EPLI Project Manager to establish financial and other performance goals

• Track the outcomes of submitted appeals to determine 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 otherwise improve outcomes

Knowledge, Skills, and Abilities

• Deep understanding of defense counsel activities and legal terminology
• Vast knowledge of insurance company Defense Counsel Billing Guidelines
• Knowledge of legal billing software such as BillBlast and Aderant, and eBilling vendors such as Legal Tracker and Tymetrix 360.
• Familiarity with the structure of large multi-office litigation law firms
• Commitment to diversity, equity, and inclusion in legal staffing
• Ability to handle sensitive matters confidentially and with professionalism
• Excellent interpersonal skills, and an ability to establish and maintain effective working relationships with internal and external personnel at all levels
• Excellent written and verbal communication skills and attention to detail
• Ability to work independently and as part of a team
• Ability to delegate, manage resources, and effectively get work done through others
• Ability to think creatively and to innovate in a fast-paced environment subject to change, new technologies, and market disruptions
• Highly organized with the ability to effectively manage various projects and prioritize multiple assignments to meet deadlines
• Must possess superior judgment and discretion and be able to protect and maintain sensitive and highly confidential information
• Ability and flexibility to travel to the firm’s offices and other events, as needed.

Education, Experience & Certification Requirements

• Bachelor’s degree required; JD strongly preferred.
• Experience as an attorney or paralegal at a large law firm or major insurance company
• 5+ years of experience in legal bill review or insurance defense work
• Preference for experience with defense of labor and employment matters
• Exceptional communication, relationship-building, and organizational skills
• Proficiency in Microsoft Office applications, including Word, Outlook, PowerPoint, and Excel in order to independently produce quality communications, track results, and create presentations

Equal Opportunity / FCA statement

Qualified applications with arrest or conviction records will be considered for employment in accordance with both the FCO and the California Fair Chance Act (FCA).

Equal Opportunity Employer

Fisher Phillips is committed to providing equal employment opportunities to all employees and applicants, regardless of race, ethnicity, religion, sex (including related medical conditions), gender, sexual orientation, national origin, citizenship status, veteran status, marital status, pregnancy, age, disability, or any other protected status, in compliance with all applicable laws.

Compensation

The hourly range for this position is $48.08 - $57.69. Actual base pay within this range will be determined by several components, including but not limited to, location, relevant experience, internal equity, skills, qualifications, and other job-related factors permitted by law.

Why Join Us

At Fisher Phillips, we believe exceptional talent is the foundation of our success and the key to delivering outstanding service to both our internal and external clients. When you join our team, you become part of a professional yet dynamic environment that embraces innovation and leverages cutting-edge technology. Our leadership is deeply committed to your growth, offering meaningful opportunities to develop your skills and take on new challenges.

We offer a competitive compensation and benefits package, including medical, dental, and vision insurance, a 401(k) with profit sharing, 15 days of paid time off (which includes sick leave where applicable), and 10 paid holidays per benefit year. To learn more about our firm, visit www.fisherphillips.com.

Additional Notes

The statements in this position description are not necessarily all-inclusive. Additional duties and responsibilities may be assigned, and requirements may vary from time to time.

As part of our initial screening process, we may use an AI tool to compare the skills and job titles from your resume with the job description, using machine learning or artificial intelligence based on their contextual meaning and relevancy. This is NOT an automated employment decision tool (‘AEDT’) and will not be used to make selection decisions. It is only used (occasionally) in addition to manual screening.

If you are a resident of New York City and would like to request an alternative evaluation process or reasonable accommodation, please email [email protected].

Relocation costs are not covered. We are only accepting direct applicants; third-party recruiters or agencies will not be considered. No phone inquiries, please.