The Negotiation Specialist evaluates and negotiates workers' compensation claims, ensuring compliance with laws while achieving fair resolutions and minimizing costs.
Job Title: Negotiation Specialist (Technical Operator III)
Department: IQ Analysis
Reports To: IQ Analysis Manager
Location: Remote
Job Type: Full-Time
Job Summary:
The Negotiation Specialist is responsible for evaluating, negotiating, and settling workers’ compensation claims in compliance with applicable laws and internal policies. This role involves working closely with providers, adjusters, and internal teams to ensure cost-effective and fair outcomes while maintaining a high standard of service.
Key Responsibilities:
- Review and analyze medical bills, treatment records, and claim documentation to determine appropriate settlement values.
- Negotiate with medical providers, and other parties to reach fair and timely resolutions.
- Ensure compliance with all applicable state workers’ compensation laws and regulations.
- Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system.
- Identify potential cost-saving opportunities and work toward minimizing claim exposure.
- Communicate clearly and professionally with both internal and external contacts.
- Monitor claims to identify trends and report on potential areas of concern.
Qualifications:
- 2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience).
- Strong knowledge of workers’ compensation regulations and fee schedules.
- Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts
- Excellent communication and negotiation skills, both written and verbal
- Strong attention to detail and ability to manage multiple cases independently
- Excellent negotiation, communication, and analytical skills.
- Ability to work independently and manage multiple priorities in a fast-paced environment.
- Proficient with claims management systems and Microsoft Office Suite.
Preferred Qualifications:
- Experience in a TPA, insurance carrier, or medical cost containment company
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