Insurance Claims Specialist

2 days ago


Cambridge, Massachusetts, United States Ternium Full time

Company Overview

Ternium is a leading healthcare provider dedicated to delivering exceptional patient care and innovative solutions. Our team of professionals is passionate about making a difference in the lives of our patients and partners.

Salary

The estimated annual salary for this role is $55,000-$65,000, commensurate with experience.

Job Description

We are seeking a skilled Staff/Associate Attorney to represent our healthcare providers in disputes with medical insurance carriers and managed care organizations. As a key member of our team, you will leverage your analytical skills to identify issues, conduct research, and develop persuasive appeal letters to resolve denied claims.

Responsibilities

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

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 ability to prioritize within a dynamic environment

Benefits

  • Full-time remote position
  • Starting salary $55,000-$65,000 per year (commensurate with experience)
  • 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 dedicated to equal employment opportunity and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment where everyone has the opportunity to thrive.



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