Claims Resolution Specialist II

CLAIMS RESOLUTION SPECIALIST II, OON

Job Snapshot

Employee Type

Full-Time

Location

United States of America (Remote)

Job Type

Insurance

Experience

Not Specified

MultiPlan United States of America (Remote) Full-Time

Job Details

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client’s needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

This position is responsible for contacting health care providers to negotiate certain type and dollar size health care claims/bills. Objective is to achieve maximum discounts and savings on behalf of the payor/client.

JOB ROLE AND RESPONSIBILITIES:

• Foster and maintain provider relationship to facilitate current and future negotiations by
• Performing claim research to provide support for desired savings;
• Generating agreements by communicating with providers by written and verbal communication throughout the negotiation process; and
• Address counter-offers received and present proposal for resolution while adhering to client guidelines and department goals.
• Seek opportunities to achieve savings with previously challenging/unsuccessful providers
• Partnering with internal and external clients, including Account Managers, Customer
• Relations, Provider Services, and direct client contacts as applicable.
• Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.
• Up to 40% of time will be on phone with providers
• Meet and maintain established departmental performance metrics.
• Manage high volume of healthcare claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.
• Must be versatile to handle multiple clients with different requirements with different rules
• Knowledge of Workers’ Compensation or automobile medical (“auto”) claims/bills is a plus:
• 5Collaborate, coordinate, and communicate across disciplines and departments.
• Ensure compliance with HIPAA protocol.
• Demonstrate Company’s Core Competencies and values held within.
• The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.

JOB SCOPE:

The individual in this position works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of health care claims/bills and provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

Job Requirements:

JOB REQUIREMENTS: (Education, Experience, and Training)

• Minimum high school diploma or GED
• Minimum of 2 years of experience in a service based industry preferably in the healthcare or medical insurance field (clinical, provider billing, provider collections, insurance or managed care preferred), or minimum 1 year experience as an Associate Claims Resolution Specialist/CRSI preferred
• Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) desired
• Knowledge of general office operations and/or experience with standard medical insurance claim forms
• Good Communication (verbal, written and listening), teamwork, negotiation and organizational skills
• o Ability to process detailed verbal and written instructions
• o Display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone
• Ability to:
• o Commit to providing a level of customer service within established standards
• o Provide attention to detail to ensure accuracy including mathematical calculations
• o Organize workload to meet deadlines and participate in department/team meetings
• o Identify issues and determine appropriate course of action for resolution
• Ability to:
• o Work with accuracy in a fast-paced environment
• o Adjust/alter workflow to meet deadlines
• o Work independently and handle confidential information
• Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software
• Required licensures, professional certifications, and/or Board certifications as applicable
• Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

BENEFITS

We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

• Medical, dental and vision coverage (low copay & deductible
• Life insurance
• Short- and long-term disability
• 401(k) + match
• Generous Paid Time Off
• Paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Summer Hours

The salary range for this position is [$20-23]. Specific offers take into account a candidate’s education, experience and skills, as well as the candidate’s work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

EEO STATEMENT

MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you’d like more information on your EEO rights under the law, please