Healthcare Dispute Resolution Specialist

20 hours ago


Cambridge, Massachusetts, United States Ternium Full time

At Ternium, we are seeking a skilled Healthcare Dispute Resolution Specialist to represent our healthcare provider partners in their disputes with medical insurance carriers and managed care organizations. As a key member of our team, you will leverage your analytical skills and knowledge of the industry to resolve denied claims and develop innovative legal arguments to effectuate positive resolution of denial medical claims.

Responsibilities:
  • Represent healthcare providers in denied claim disputes, primarily shepherding disputes through an administrative appeals process (no litigation involved).
  • Develop novel legal and procedural arguments to resolve denied medical claims.
  • Draft complex and persuasive appeal letters to insurance organizations and benefit administrators.

This is a non-traditional legal role where you will apply your analytical skills to identify issues, conduct research, and draft compelling arguments to support business models. If you have a strong understanding of commercial and managed care insurance claims policies and procedures, as well as ERISA regulations, this could be the ideal opportunity for you.



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