Health Insurance Claims Specialist

Crowell & Moring • Washington, DC

2d • $76,000 - $140,000 • Remote

About The Position

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

The Health Insurance Claims Specialist supports attorneys by reviewing claim files, compiling factual summaries, identifying key documents, and facilitating legal analysis concerning liability, potential defenses, exposure valuations, and settlement strategies. The role reviews healthcare claim files in payor/provider disputes, evaluates batches of claims, validates client claim analyses and data, and maintains case summaries, trackers, and databases. It synthesizes information into actionable summaries that support legal analysis and trial strategy.

Requirements

• Bachelor’s degree or an equivalent combination of education and experience.
• At least three years of experience in healthcare claims analysis, insurance claims, payor-provider disputes, litigation support focused on managed care or regulatory compliance, or a related field.
• Familiarity with healthcare 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 the ability to produce clear, concise, structured claim summaries.
• Excellent attention to detail, critical-thinking, and organizational skills.
• Ability to collaborate with attorneys and clients to support litigation teams.

Nice To Haves

• Proficiency with MS Suite and data-driven analysis tools, including document management systems, claims platforms, or litigation databases.
• Prior experience at a law firm or insurance company handling healthcare litigation or audits.
• Familiarity with CMS manuals, coverage determinations, and medical necessity standards.
• Understanding of sampling and extrapolation methodologies.

Responsibilities

• Review and analyze healthcare claim files involving payor/provider disputes, identifying patterns and administrative issues such as coding errors, denial reasons, and medical necessity claims.
• Evaluate the merits and potential liability of claim batches to assess their applicability to claims in dispute.
• Review client claim analyses and data 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level