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In-House
Attorney
Insurance
Litigation - Insurance
Min 5 yrs required
Associate Claims and Resolution Analyst The candidate will provides assistance in claim resolution for higher complexity claims and those in litigation. Will provides negotiation services to achieve higher client discounts on claims. Will work for a place where management encourages responsibility, communications and problem solving. Will determine the optimal claims resolution strategy based on Client, Facility and identified hospital bill review exceptions. Will modify claims resolution strategies and legal arguments as warranted to ensure successful closure. Will recommend and ensure that the Client is in agreement with the proposed claims resolution strategy, including—but not limited to—acceptance of all identified hospital bill review exceptions, out-of-network discount, additional in-network discount, negotiation and settlement, or expiration of provider appeals timeline. Will work with the Clinical, Account Management and/or Legal Teams as required to uphold hospital bill review exceptions through the claims settlement or provider appeals process. Will lead the claims resolution effort for assigned claims, including all verbal and written communication with Facilities, Clients and other third parties. Will understand and maintain HIPAA confidentiality and privacy standards when completing assigned work. Will contribute to development of business rules, regulations and process improvements. Will contribute to development of/enhancements to internal systems (ex. Information technology system).
Qualification and Experience
The candidate should have Bachelor’s Degree; emphasis in nursing, accounting, finance, law or business administration preferred. Should have minimum 5 years of progressive business experience preferably in a managed care environment. Provider relations, negotiation and contracting experience, large claims resolution or other negotiation experience required. Good computer skills, including—but not limited to—Word and Excel.
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