Claims Specialist - NSA/IDR - Curative HR LLC

Claim Specialist needed to combat rising healthcare costs and empower health plans! Curative Health Plan  provides our clients with innovative cost-cutting solutions and innovative service offerings. We continue to enjoy growth thanks to our most valuable resource – our talented and committed team.

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 Claim Specialist will be responsible for supporting the team on all aspects of the No Surprises Act, including reviewing medical claims, keeping track of strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution, among many other tasks. The candidate will also be expected to support the team on balance billing and overpayment matters as needed. 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.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Manage a daily running inventory of unpaid claims or claim disputes.

• Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards.

• Contact facilities and providers to discuss charge adjustments and rationale.

• Contact facilities and explain benefits to resolve payment disputes.

• Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities.

• Capture detailed notes on calls for future reference.

• As needed, handle member inquiries in accordance with their medical plan.

• Work with Curative’s legal department to ensure escalation of claims.

• Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process.

• Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

Experience and Qualifications

• Preferred: Baccalaureate degree (BA/BS) from an accredited college or university.

• Preferred: Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting.

• Computer literate, including Google Workspace products.

• Looker software experience is a plus.