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Claims Negotiator I
Chicago, IL
Job Description
CLAIMS NEGOTIATOR I
POSITION SUMMARY
The Claims Negotiator will work with medical Providers to negotiate balances outstanding on member's claims. Responsibilities include managing multiple claims cases, interfacing with internal staff and external Providers to understand and negotiate claims balances. Documentation and follow-up to ensure all aspects of the negotiation are completed in accordance with the health plan.
ESSENTIAL FUNCTIONS
POSITION SUMMARY
The Claims Negotiator will work with medical Providers to negotiate balances outstanding on member's claims. Responsibilities include managing multiple claims cases, interfacing with internal staff and external Providers to understand and negotiate claims balances. Documentation and follow-up to ensure all aspects of the negotiation are completed in accordance with the health plan.
ESSENTIAL FUNCTIONS
- Negotiate medical claims with healthcare Providers.
- Send and acknowledge receipt of contracts from Providers.
- Track all Settlements.
- Correspond with clients, medical Providers, and reinsurance carriers over the phone and via email.
- Review and understand the terms and conditions of group health plans and reinsurance policies.
- Understand and comply with all applicable privacy and security laws, including HIPAA and any regulations promulgated thereto.
- Consult with other entities who can offer additional evaluation of a claim.
- Review, analyze, and add applicable notes to the Qiclink System.
- Assist and support other team members as needed and when requested.
- Attend continuing education classes as required, including HIPAA training.
- Perform other duties and special projects as requested.
EDUCATION
- Bachelor's degree or equivalent work experience required
EXPERIENCE AND SKILLS
- 1-3 years of experience in a Call Center or Customer service role.
- Experience with medical claims preferred.
- Effective communication skills to interact with members, Providers, and insurance carrier representatives, emphasizing ability to communicate verbally and in writing.
- Assertive, self-confident, and resilient.
- Proficiency in Microsoft Word and Excel
- Ability to search and identify resources through the internet.
- Demonstrated ability to communicate concepts, strategies, and plans in terminology understood by business professionals.
- Ability to interpret Explanation of Benefits (EOBs).
- Familiarity with several types of health insurance coverage, coordination of benefits, and UCR fees.
- Highly effective time management skills
- Strong attention to detail, accuracy, fairness, and impeccable organization
POSITION COMPETENCIES
- Job Knowledge
- Time Management
- Accountability
- Communication
- Initiative
- Customer Focus
PHYSICAL DEMANDS:
This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT:
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
This is a standard desk role - long periods of sitting and working on a computer are required.
WORK ENVIRONMENT:
Remote
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
1 to 3 years
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