Insurance Claim Resolution Specialist

19 hours ago


Cambridge, Massachusetts, United States Ternium Full time

Why Work for Ternium:

We offer a comprehensive benefits package, including a competitive starting salary, 401(k) with corporate match, dental insurance, employee assistance program, flexible schedule, health insurance, vision insurance, life insurance, paid time off, and bonus opportunities. Our team is passionate about making a difference in the lives of our clients and colleagues alike. If you're looking for a challenging and rewarding role in a dynamic company, we encourage you to apply.

About the Job:

This full-time remote position offers a unique opportunity to join a growing company and make a meaningful impact in the healthcare industry. As a Staff/Associate Attorney, you will represent healthcare providers in disputes with medical insurance carriers and managed care organizations. Your expertise will be essential in developing innovative legal and procedural arguments to effectuate positive resolution of denial medical claims.

Responsibilities:

  • Represent healthcare providers in denied claim disputes through an administrative appeals process.
  • Develop innovative legal and procedural arguments to effectuate positive resolution of denial medical claims.
  • Draft complex and persuasive appeal letters to insurance organizations and benefit administrators.
  • Leverage payor provider manuals and managed care contracts to successfully resolve denied medical claims.
  • Work directly with provider representatives and enhanced resolution units to resolve complex issues.
  • Provide education, payor trends, denial trends, and training of recovery staff team members at partner provider organizations.

Requirements:

  • Juris Doctor required
  • State Bar Membership (preferred)
  • Strong analytical and problem-solving skills
  • Excellent written and verbal communication skills
  • Ability to work independently and as part of a team
  • Attention to detail and the ability to prioritize within a dynamic environment
  • Ability to adhere to all HIPAA and company policies and regulations


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