– Appeal Representative (US Workers’ Compensation)Position Overview

We are looking for an experienced Appeal Representative – US Workers’ Compensation to manage the end-to-end appeal process for denied Workers’ Compensation claims. The ideal candidate should have strong knowledge of US Workers’ Comp billing, denial management, payer requirements, and appeal submission processes.

Key Responsibilities

- Review and analyze Workers’ Compensation claim denials to identify the root cause and appropriate resolution.
- Prepare and submit first-level and subsequent-level appeals within payer and state-specific filing deadlines.
- Review EOBs/ERAs, denial codes, claim history, medical records, bills, authorization information, and supporting documentation.
- Determine the appropriate appeal strategy and required documentation based on the denial reason.
- Prepare strong, well-supported appeal letters with relevant claim, clinical, authorization, and billing information.
- Work claims through DaisyBill and other Workers’ Compensation platforms/portals.
- Track appeal submissions, follow-ups, payer responses, and appeal outcomes.
- Coordinate with billing, coding, authorization, clinical, and provider teams to obtain missing documentation.
- Research state-specific Workers’ Compensation rules, payer guidelines, fee schedules, filing limits, and reimbursement requirements.
- Identify underpayments, incorrect denials, authorization issues, bundling/edit issues, and other reimbursement discrepancies.
- Maintain accurate notes and documentation for every appeal action taken.
- Escalate complex or high-value claims when additional review is required.
- Meet productivity, quality, turnaround-time, and recovery targets.

Required Qualifications
- 2+ years of experience in US Workers’ Compensation billing, AR, denial management, or appeals.




- Strong understanding of the US Workers’ Compensation claims lifecycle.
- Hands-on experience with Workers’ Comp denials and appeal/resubmission processes.
- Robust knowledge of CPT, HCPCS, ICD-10, modifiers, authorization requirements, and claim forms.
- Ability to interpret EOBs/denial codes and determine appropriate corrective action.
- Strong written English and ability to prepare professional, fact-based appeal letters.
- Strong attention to detail and ability to manage high-volume claims.
- Experience working with payer portals and Workers’ Compensation systems.

Preferred Qualifications
- Experience with DaisyBill is highly preferred.
- Experience with Waystar, Availity, Jopari, or similar RCM/clearinghouse platforms is an advantage.
- Knowledge of California Workers’ Compensation is a strong plus.
- Experience handling medical necessity, authorization, coding, timely filing, fee schedule, and documentation-related denials.
- Experience with Workers’ Compensation regulations across multiple US states is preferred.

Key Skills
- Workers’ Compensation Appeals
- Denial Management
- AR & Claims Follow-up
- Appeal Letter Writing
- DaisyBill
- EOB/ERA Analysis
- CPT/HCPCS/ICD-10
- Medical Billing & Coding
- Payer Research
- Documentation Review
- Claim Resolution
- Strong Written & Verbal Communication

Performance Expectations
- Timely submission of appeals before filing deadlines.
- High-quality and accurate appeal documentation.
- Strong appeal overturn/recovery rate.
- Accurate claim notes and follow-up documentation.
- Consistent achievement of productivity and quality targets.

Employment Type: Full-Time Shift: US Shift / Night Shift

Location: India / Remote or Hybrid

Experience: 2+ years in US Workers’ Compensation Appeals/AR

Pay: ₹300,000.00 - ₹450,000.00 per year

Benefits

- Commuter assistance
- Health insurance

Work Location: In person

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