Claims Specialist

We are seeking an experienced Out-of-Network Claims Negotiation Specialist to negotiate and resolve balance billing disputes, out-of-network claims, and provider payment issues on behalf of union members.

This is a temporary, possible temporary to direct hire opportunity, fully on-site. Monday through Friday, 9am to 5pm.

Key Responsibilities:

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• Negotiate out-of-network medical bills, provider fees, and payment disputes to minimize members' out-of-pocket expenses.
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• Resolve balance billing inquiries through communication with providers, attorneys, collection agencies, and members.
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• Negotiate claims subject to the No Surprises Act (NSA), aiming to resolve disputes before escalation to Independent Dispute Resolution (IDR).
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• Review claims, eligibility, benefits, and provider contracts to identify billing discrepancies and ensure accurate payments.
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• Utilize claims databases and reimbursement benchmarks to determine reasonable payment rates.
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• Identify potential billing irregularities, contractual violations, and provider contracting opportunities.
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• Collaborate with internal departments to resolve complex claims and ensure timely resolution.
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Qualifications:

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• High School Diploma Required. Associates Degree highly preferred.
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• Must have 2-3 years of experience working with medical/hospital claims and 2-3 years of claims negotiation experience.
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• Experience in healthcare claims, medical billing, provider negotiations, or insurance reimbursement.
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• Knowledge of out-of-network claims, balance billing, and the No Surprises Act (NSA) preferred.
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• Strong negotiation, analytical, communication, and problem-solving skills.
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• Ability to manage a high volume of inquiries and complex claims.
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