Job Description
As a Senior Appeals Specialist – Workers’ Compensation, you will play a critical role in resolving post-payment disputes related to Workers’ Compensation bills. This includes conducting provider outreach, negotiating disputed charges, and ensuring compliance with state-specific regulations. Your work will directly support our cost containment efforts and ensure appropriate bill reimbursement for our clients.
Primary Responsibilities include managing a caseload of post-payment Workers’ Compensation bills, conducting proactive outreach to medical providers to explain payment methodologies, resolve disputes, and negotiate reductions on appealed or outlier bills. The specialist will educate providers on Workers’ Compensation billing and reimbursement policies and regulatory requirements as well as oversee all DWD handling and state dispute referrals to attorneys. The Senior Appeals Specialist should identify opportunities for enhancement either through automation or process changes that increase efficiency for the team and ensure that individuals meet their personal goals.
About Point C Health
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs.