Workers' Appeals Manager

Our growing national healthcare organization operates in 47 states, and we’re looking for a Workers’ Compensation Appeals Manager to join our team! In this role, you’ll own the appeals process for denied and underpaid claims, driving incremental revenue through strategic payor partnerships, strong adjuster relationships, and full accountability for Appeals Management.

💼 Why this role matters: Your expertise will directly impact our bottom line and help us deliver better outcomes for providers and patients.

💰 Compensation: Base salary ($90k-$110k depending on experience) plus bonus. Earn up to an additional $50K annually based on achievement of specific KPIs.

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Location:

This individual will be located near one of our three offices:
Edina, MN;
Tucson, AZ; or Bingham Farms, MI as in office days are required, with hybrid flexibility. Regular travel to each location will be required to maintain strong connections with the team and key stakeholders.

• Own the full lifecycle of denied and underpaid workers’ comp claims, from analysis to appeal to resolution.
• Build and submit compelling first-, second-, and third-level appeals using clinical documentation, statutes, payer policy, state specific rules, and state specific laws.
• Proactively follow up with adjusters, nurse case managers, TPAs, and payers to hold them accountable.
• Negotiate, escalate, and resolve issues with persistence and professionalism.
• Track deadlines, reconcile payments, and maintain meticulous documentation.
• Collaborate across billing, intake, and authorization teams to ensure airtight claim submissions.
• Use AI tools and data insights to streamline processes and identify trends in denials.
• Meet or exceed company benchmarks and goals for appeals timelines and successful appeals wins obtaining payments.
• Use company reporting and KPI’s to track and adjust your focus and efforts.
• Manage third party collections efforts and litigation processes and oversight on unpaid workers compensation claims.
• Assist in guiding our organization on updated policies and procedures state by state in getting higher levels of approval/payments and minimizing loses form unpaid claims.

• 5–10 years of experience in workers’ compensation billing, appeals, or A/R.
• High school diploma or equivalent required; associate’s degree or healthcare admin certification preferred.
• Deep knowledge of state-specific workers’ comp regulations, fee schedules, and payer protocols.
• Possesses a strong understanding of the insurance industry, including common practices and strategies used in claims management.
• A proactive, self-starting mindset with a drive to see things through to resolution.
• We’re looking for a results-driven professional with a relentless commitment to excellence, someone who thrives in competitive environments, embraces challenges, and consistently pushes for top performance
• Excellent written and verbal communication skills, you’re clear, assertive, and professional.
• Tech-savvy with tools like Microsoft Office or Google Workspace; experience with Net Suite, Daisy Bill, Dialpad, or Box is a plus.
• Bonus points for multi-state or national experience and familiarity with DME work comp billing.