Healthcare Insurance Claims Specialist

17 hours ago


Cambridge, Massachusetts, United States Ternium Full time

At Ternium, we are seeking a skilled Healthcare Insurance Claims Specialist to join our team. This is an exciting opportunity to leverage your legal education in a non-traditional legal role.

The estimated salary for this position is $60,000-$70,000 per year, commensurate with experience. Benefits include full-time remote work, 401(k) with corporate match, dental insurance, employee assistance program, flexible schedule, health insurance, vision insurance, life insurance, paid time off, and bar due reimbursement.

In this role, you will represent healthcare providers in their disputes with medical insurance carriers and managed care organizations across the full spectrum of administrative appeal processes. You will develop a foundational understanding of the industry and develop strong aptitudes in the areas of Commercial and Managed Care Insurance Claims policies and procedures, and ERISA regulations as it relates to administrative processing of claims, claim payment, coverage determinations, dispute resolution, and other relevant concerns.

You will be responsible for representing healthcare providers in denied claim disputes, primarily shepherding disputes through an administrative appeals process (no litigation involved). You will also draft complex and persuasive appeal letters to insurance organizations and benefit administrators, leveraging payor provider manuals and managed care contracts to successfully resolve denied medical claims.



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