Managed Care Attorney Advisor

1 day ago


Cambridge, Massachusetts, United States Ternium Full time

About the Role:

The Insurance Claims Specialist will be responsible for representing healthcare providers in their disputes with medical insurance carriers and managed care organizations.

This is a non-traditional legal role that requires leveraging legal education in a variety of ways, including analytical analysis and issue identification, contract reviews, statutory research and application, and persuasive appeal drafting.

The ideal candidate will have a Juris Doctor degree, strong analytical and problem-solving skills, and excellent written and verbal communication skills.

Responsibilities:

  • Represent healthcare providers in denied claim disputes, primarily shepherding disputes through an administrative appeals process (no litigation involved).
  • Develop innovative and novel 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 successfully resolve complex issues.

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

Benefits:

  • Full-time
  • Remote
  • 401(k) with corporate match
  • Dental insurance
  • Employee assistance program
  • Flexible schedule
  • Health insurance
  • Vision insurance
  • Life insurance
  • Paid time off
  • Bar Due reimbursement
  • Bonus opportunities

Equal Employment Opportunity:

Ternium is an equal employment opportunity employer and welcomes applications from diverse candidates.


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