by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.
Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!
This role manages a "paperless" healthcare subrogation case load through investigation, pending and settlement stages of the recovery process. The Discovery work environment is team oriented; the incumbent will coordinate efforts with the team and attorneys to bring matters to efficient and successful outcomes. The incumbent's primary responsibility will be negotiating reimbursement of the health plan's lien on settlement proceeds and is accountable for managing the coordination of claim payments among health plans and other responsible parties through recovery of 1st and 3rd party funds.
JOB ROLES AND RESPONSIBILITIES:
1. Conduct due diligence (e.g. online research, insurance verification, and court record searches) to assist with collections and preservation of lien rights
2. Work all aspects of the recovery process following client specific procedures and guidelines, and maintain a calendar diary to monitor case activity, and provide feedback to management and unit on trends or developments
3. Negotiate health plan medical claim settlements
4. Identify and develop subrogation opportunities and place parties of interest on notice
5. Respond timely to all electronic, written and verbal communications, log information derived from written and verbal communication; where required maintain detailed and accurate records
6. Research and request case information to develop cases, access and pull benefits from clients' remote health claim systems
7. Pursue worker's compensation, third party liability, first party uninsured and underinsured recovery, worker's compensation, med-pay coverage and no-fault recoveries.
8. Understand basic health plan contractual provisions and apply to the reimbursement efforts, ensure compliance of state and federal laws and settlement authority levels
9. Maintain department productivity and quality standards
10. Sensitivity to privacy in accordance with HIPAA guidelines
11. Collaborate, coordinate, and communicate across disciplines and departments.
12. Ensure compliance with HIPAA regulations and requirements.
13. Demonstrate Company's Core Competencies and values held within.
14. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
15. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
Keep the needs of external and internal customers as a priority when making decisions and taking action. Operates independently under limited supervison. Has decision making authority within specified parameters and must Engage advice and/or help of legal manager to proactively resolve cases. Works across customers, beneficiaries, providers, and suplimental payors while maintaining positive relationships.
Note: This job cannot be performed in Colorado.
JOB REQUIREMENTS (Education, Experience, and Training):
* Bachelors' degree in a related field coupled with at least five (5) years' experience in a legal environment, three (3) of which should be inclusive of direct experience in negotiation
* Paralegal Certificate Preferred
* Proficiency with Microsoft Word, Excel, internet research skills
* Good judgment, discretion, maturity, professionalism, and razor-sharp attention to detail.
* Excellent written and communication skills.
* A "roll-up your sleeves" attitude, and team player mindset are must haves for this position.
* Aptitude for navigating complex issues.
* Skilled at identifying and summarizing red flags/key risks.
* Ability to navigate through ambiguity and thrive in a fast-paced, dynamic environment while juggling priorities and deadlines.
* Required licensures, professional certifications, and/or Board certifications as applicable.
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone
We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.
Your benefits will include:
- Medical, dental and vision coverage (low copay & deductible
- Life insurance
- Short- and long-term disability
- 401(k) + match
- Generous Paid Time Off
- Paid company holidays
- Tuition reimbursement
- Flexible Spending Account
- Employee Assistance Program
- Summer Hours
MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please [ Link removed ] - Click here to apply to Negotiator.
- Attention To Detail
- Decision Making
- Professional Attitude
- Verbal Communication