Claims Negotiator

Job Summary

A company is looking for a Claims Negotiator I.

Key Responsibilities

• Negotiate out-of-network claim payments with providers based on cost data and billing irregularities
• Review and analyze health care claims for reasonableness, medical necessity, and fraud
• Document and log negotiated claims into the Access database and create weekly summary reports

Required Qualifications

• Bachelor's degree or equivalent work experience required
• A minimum of 5 years of medical claims analysis experience required
• Strong analytical skills
• Knowledge of computer systems and CPT and ICD-9 coding terminology
• Understanding of HIPAA and applicable privacy and security laws