No Surprises Act Claims Negotiator

The Phia Group; Louisville (KY); On-site; USD 52,000 - 78,000; Full time

Job summary

The Phia Group, a service-oriented health-care consultant, seeks a Claim Specialist to support No Surprises Act tasks, review medical claims, and draft settlements. You will help manage disputes, balance billing, and overpayments, while maintaining professional communication with providers and plans.

Ideal candidates will have a BA/BS and experience in healthcare claims, with negotiation exposure. The role demands proactive, persuasive, and multi-tasking capabilities in a fast-paced environment.

Qualifications

• Preferred: BA/BS from an accredited college or university.
• Experience in a medical healthcare claims role, preferably with negotiation.
• Experience at an insurance company, TPA, or hospital.

Responsibilities

• Manage daily running inventory of unpaid claims or claim disputes.
• Review and prioritize claims based on processing criteria and deadlines.
• Contact facilities to discuss charge adjustments and benefits.
• Draft correspondence for settlement and negotiation efforts.
• Capture detailed notes on calls for future reference.
• Handle member inquiries in accordance with the medical plan.
• Coordinate with the legal department to escalate claims.

Skills

No Surprises Act

Claims review

Settlement negotiations

HIPAA compliance

Education

BA/BS in a related field

Job description

The Phia Group, a service-oriented health-care consultant, seeks a Claim Specialist to support No Surprises Act tasks, review medical claims, and draft settlements. You will help manage disputes, balance billing, and overpayments, while maintaining professional communication with providers and plans.

Ideal candidates will have a BA/BS and experience in healthcare claims, with negotiation exposure. The role demands proactive, persuasive, and multi-tasking capabilities in a fast-paced environment.