Healthcare Claims Negotiator Jobs

Experience in sales, customer service and/or financial services are all highly desirable

Two or four year college degree preferred; however, those with college coursework or relevant experience will be considered.

Providing the highest level of customer service

Determine accounts eligible for settlement based on relevant factors regarding clients account

Negotiating favorable settlements directly with creditors on behalf of our clients

Coordinating with clients the terms of debt resolutions

Knowledge of basic spreadsheet / word processing / data entry and basic math skills required.

Knowledge of Claims Management and URAC standards preferred.

Tracks claim detail errors and communicates to up-line management for coaching and training purposes.

Must have minimum 1 year work experience.

Two years of customer service, claims processing, medical terminology, medical services or equivalent experience required.

Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.

Knowledge of basic spreadsheet / word processing / data entry and basic math skills required.

Knowledge of Claims Management and URAC standards preferred.

Tracks claim detail errors and communicates to up-line management for coaching and training purposes.

Must have minimum 1 year work experience.

Two years of customer service, claims processing, medical terminology, medical services or equivalent experience required.

Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.

BBA or BS in Petroleum Land Management/Energy Management, business, or related field

Exceptional communication skills. Communicates with clarity and integrity and understands the need for constant and consistent dialog.

Good interpersonal, communication (oral and written) and teamworking skills.

Minimum of 6 years of in-house subsurface land negotiations experience.

Experience with complex Eagle Ford leases and agreements preferred.

The Land Negotiator develops relationships within the oil and gas industry to facilitate partnering and trade opportunities.

Run reports, Data Entry, Faxing, Filing and other administrative duties as needed

Develop and maintain a knowledge base of the evolving services

1+ years of customer service experience, preferably in an office or call center environment

Excellent communication skills (both written and verbal). Bilingual is a plus!

Strong follow-up and organizational skills

Contacting creditors and collection agencies to obtain or verify account details

In Depth Experience & Understanding of Coverage & Reimbursement, Member Enrollment, Provider Contracts, Benefits and Authorization and Claims Workflow

"A la Carte" Style Benefits

3+ Years of Experience in Data Analysis, Claims Configurations within QNXT or Similar Software/Application

$50.00 - $55.00 / Hourly Rate

Estimated 6 Month Contract Period

Paid Time Off / Sick Leave / Etc.

Prepare reports for management by collecting, analyzing, and summarizing claim information.

Maintain proper file documentation of assigned files by complying with company and state requirements.

2+ years of experience in the legal or medical field.

Experience with Professional Liability preferred.

Responsibilities include, but are not limited to:

Actively engage in review processes to evaluate liability, assess case value, and oversee reserving functions and total claims costs.

7 years of experience in energy project development, utility procurement, or finance/consulting roles with similar responsibilities.

Knowledge of energy transaction structuring, power markets, utility rates, renewable energy technologies, and/or infrastructure project management.

Bachelor's degree in Business, Economics, Finance, Engineering, or equivalent practical experience.

7 years of experience in the electric power industry, structuring and negotiating agreements.

7 years of experience with quantitative analysis, including financial modeling.

Master’s degree in Business, Economics, Finance, Engineering, or a related field.

Support analytical needs during the sourcing strategy, suppliers’ relationship management, management of complaints, and demand processes management

Support monitoring and management of the suppliers’ performance in his/her regional division

Training: Engineering, management or related

Negotiate the categories under his/her responsibility in order to get the greatest value for the company.

Obtain and analyze current and historical information on the sourcing process based on specific categories to identify potential opportunities

Carry out analysis to determine compliance with suppliers, contracts, and/or purchase channels based on the reports time lines and scope

• COB and benefit summary knowledge

• Pay or deny claims according to the benefit summary

• Priority will be given to those with knowledge of the QNXT systems and application

• Knowledge of Medicaid, Medicare or commercial claims processing

• Experience with claims or customer service in medical field

• Review membership eligibility for determination

Maintain all managed file transfer processes to standard levels and continuous improvement efficiencies.

Identifies applicable security/data standards when reviewing requirements and recommends controls to ensure compliance

Respond to and resolve data transfer and integration incidents

Analyze issues to detect recurring problems.

Partner with internal teams to resolve issues

Document issue resolution and any mitigation plans/efforts for preventing the issue from reoccurring in the future

2+ years' experience with data visualization in Tableau or PowerBI

We welcome 100% remote work for residents of the States of Oregon and Washington.

Required Qualifications For This Position Include

Preferred Qualifications For This Position Include

Be responsible for designing, implementing, and coordinating data analysis projects

Provide analytical support for accreditation and external regulatory agency audit activities, operational healthcare metrics

Drafts and reviews contract documents, RFPs, supplemental agreements, consent agreements and related documents that include all mandated requirements.

Organized, detail oriented, methodical, and a multi tasker.

Facilitates the RFP process and communicates with vendors to provide required information.

Evaluates requests for additional work and negotiates supplemental agreements with consultants and contractors.

Negotiates contract costs in accordance with established authority policies.

Recommends contract provisions and procedures.

2+ years' experience with data visualization in Tableau or PowerBI

We welcome 100% remote work for residents of the States of Oregon and Washington.

Required qualifications for this position include:

Preferred qualifications for this position include:

Check out our benefits page for more information about our Benefits and Rewards.

Be responsible for designing, implementing, and coordinating data analysis projects

Exercise exceptional customer service skills in an effort to optimize each contact with the member

Minimum of one year customer service, healthcare, or claims processing experience required.

Basic Knowledge of MS Word and Excel required

Group Benefits (Fully Insured vs. Self-Insured)

Medical Benefits (CDHP/HDHP, PPO, POS, and HMO Plans)

Ability to interpret Explanation of Benefits (EOBs).

Experience with negotiation software tools such as Microsoft Word and Adobe Acrobat markup features, and contract management platforms.

Experience in research administration at an institution of higher education.

Certified Research Administrator (CRA) or Certified Federal Contracts Manager (CFCM), other comparable professional certification.

Commensurate with education and experience ($60,000 - $72,000 )

Two years experience in the processing, negotiating, and/or administration of grants, contracts, or cooperative agreements.

Accuracy, attention to detail, and ability to manage conflicting demands.

Job Title: Client Relationship Manager / Medical Claims Processing

Job Location: Baltimore, MD (Remote)

Job Duration: 10 Months CTH

5 years with medical customer service involvement

1-2 medical claims processing background

Do not need a Salesperson here, need a customer engineer background with Healthcare claims is a must

Develop expertise in the contract lifecycle management system used to track requests, obtain required approvals, and store contracts/amendments.

Manage initial negotiation escalations and track initial deal concessions. 

5+ years of relevant experience in an in-house legal department

Bachelor’s degree or equivalent work experience required

Strong experience with reviewing, analyzing, drafting, communicating, and negotiating commercial agreements. 

Experience reviewing data privacy and security agreements is a plus

Minimum of two years medical claims processing experience

Knowledge of healthcare collection procedures and microcomputer software/hardware

Effective analytical and communication skills

Ensure the coordination of claim activities and designated agencies, and the timely reimbursement of receivables.

Research, resolve, and prepare claims that have not passed the payer edits daily. Determine and initiate action to resolve rejected invoices.

Analyze each agency's outstanding monthly accounts receivable, and process claims to obtain zero balances.