Claims Negotiation Specialist

Claims Negotiation Specialists are needed to combat rising healthcare costs and empower health plans!

Until recently, surprise medical bills were a leading cause of financial distress and bankruptcy for American families. “Surprise” billing occurs when a patient presents to an out-of-network medical provider through no fault of their own – like in the case of an emergency – and the patient becomes responsible for amounts beyond what their insurance pays. Thankfully, beginning in 2022 with the implementation of the “No Surprises Act”, the legislature effectively banned surprise billing, instead

prescribing a system of negotiation and arbitration that health plans and providers must follow to resolve billing disputes.

The Claims Negotiation Specialists primary goal will be to maximize cost savings through strategic negotiation on out-of-network claims and will be responsible for supporting the team on all aspects of the No Surprises Act. This position requires someone that is proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. Curative Health Plan is growing quickly and so the candidate must be comfortable in a dynamic fast-paced environment.

Key Responsibilities

• Validate out-of-network status.
• Engage with medical providers to negotiate optimal discounts on out-of-network claims submitted.
• Maintain daily dispute reporting, keeping track of strict deadlines.
• Calculate accurate U&C and benchmark medical costs in order to draft settlement agreements.
• Monitor negotiated claims reprocessing to ensure timely response and meet turnaround expectations.
• Assist providers with any related disputes or issues, ensuring a smooth resolution process.
• Work in conjunction with various departments within Curative, including, but not limited to the Claims, Network and Legal Teams to resolve disputes.
• Draft summaries on escalated cases
• Maintain a thorough awareness of and adhere to Curative’s standards concerning privacy regulations.
  
  

Required Skills

• Proficient negotiation skills with a track record of achieving favorable results.
• Exceptional communication and interpersonal skills, with the ability to establish and
  
  

maintain relationships with medical providers.

• Strong aptitude for managing disputes and resolving issues effectively.
• Familiarity with healthcare regulations and compliance standards.
• Experience with Texas Department of Insurance (TDI) and working knowledge of the No
  
  

Surprises Act (NSA) a plus.

Qualifications

• Proven experience in healthcare claims negotiation or a related field.
• Comprehensive understanding of out-of-network claims processes.
• Ability to collaborate effectively within a team environment.