Managed Care Attorney Advisor
1 day ago
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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