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Claims Resolution Specialist, OON II at MultiPlan in Naperville, Illinois

Posted in Other 12 days ago.

Type: Full Time

Job Description:

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company that helps our customers thrive by interpreting our client's needs and tailoring innovative cost management solutions.

We are MultiPlan and we are where bright people come to shine!

Come and show off your negotiation skills as a Claims Resolution Specialist for MultiPlan!

This position is seated in our Newtown Square, PA office and is responsible for negotiating certain type and dollar size of assigned claims/bills with generally lower complexity on behalf of the payor to achieve maximum discount and savings.


1. Foster and maintain provider relationship to facilitate current and future negotiations by

* Performing claim research to provide support for desired savings;

* Generating agreement by communicating with provider by written and verbal communication throughout the negotiation process; and

* Partnering with internal and external clients, including Account Managers, Customer Relations, Provider Services, and direct client contacts as applicable.

2. Meet and maintain established departmental performance metrics. Manage high volume of claims in a queue; keep current with all claim actions and meet client deadlines for working and closing claims.

3. Initiate provider telephone calls with respect to proposals, overcome objections and apply effective telephone negotiation skills to reach successful resolution on negotiated claims.

4. Address counter-offers received and present proposal for resolution while adhering to client guidelines and department goals.

5. Seek opportunities to achieve savings with previously challenging/unsuccessful providers.

6. Collaborate, coordinate, and communicate across disciplines and departments.

7. Ensure compliance with HIPAA protocol.

8. Demonstrate Company's Core Competencies and values held within.

9. 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.

Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.


The incumbent works under general supervision to complete job responsibilities in applying a fundamental knowledge of principles, practices and procedures related to the negotiation of provider agreements. Work is sometimes complex and requires some independent judgment within established guidelines. More complex issues are referred to higher levels. This job has regular contact with internal and external customers.

* Minimum high school diploma or GED

* Minimum of 2 years of experience in a service based industry preferably in the healthcare or medical insurance field (clinical, provider billing, provider collections, insurance or managed care preferred), or minimum 1 year experience as an Associate Claims Resolution Specialist/CRSI preferred

* State license certification preferred

* Additional licensures, professional certifications, and/or Board certifications required as applicable

* Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) desired

* Knowledge of commonly used medical data resources preferred.

* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ('auto') bills:

* Knowledge of general office operations and/or experience with standard medical insurance claim forms

* Communication (verbal, written and listening), teamwork, negotiation and organizational skills

* Ability to commit to providing a level of customer service within established standards

* Ability to provide attention to detail to ensure accuracy including mathematical calculations

* Ability to organize workload to meet deadlines and participate in department/team meetings

* Ability to analyze data and arrive at a logical conclusion

* Ability to identify issues and determine appropriate course of action for resolution

* Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone.

* Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software

* Ability to work with accuracy in a fast-paced environment

* Ability to adjust/alter workflow to meet deadlines

* Ability to work independently and handle confidential information

* Ability to process detailed verbal and written instructions

* 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

* Prior history and demostrated success in a changing environment

* Ability to prioritize and complete tasks in a timely manner: with a high volume inventory, daily tasks, familiar with task lists and checklists

*Ability to maintain accurate and timely written diary and/or notes of negotiation activity

*Demonstrated success with difficult and or challenging customers, patients, clients, etc.

*Ability to interpret and/ or explain complex informaiton and support decisions/outcomes

As a Claims Resolution Specialist with MultiPlan, you will be part of an organization with a proud 30-year legacy of experience and growth. 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
* Life insurance
* Potential of bonuses based on performance

* Optional and dependent life insurance
* Short- and long-term disability
* 401(k) employer matching
* Paid time off (earn 20 days per year)
* Paid company holidays
* Floating holiday
* Tuition reimbursement
* Flexible Spending Account
* Employee Assistance Program

Opportunity. Recognition. Satisfaction. Grow your career with MultiPlan!


As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled