Health Care Claims Specialist - Chicago

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.

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

• 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

Job description