OON Mandate Negotiation Analyst
NJM Insurance Group
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Salary
💰 $55,286 - $73,404 per year
About the role
- Manage the resolution of out of network billing disputes
- Handle negotiation cases within regulatory timeframes
- Timely and accurate creation and closure of Interactions and Intents via SharePoint
- Completion of eligibility verification upon assignment of mandated cases
- Interacts with relevant parties for negotiation resolutions
- Research and review negotiation attempts for accuracy
- Update high dollar negotiation files
- Prepare written responses including negotiation outcomes
- Handle responses for Escalated complaints from CMS/DOBI/DOL
- Conduct detailed root cause analysis
Requirements
- High School Diploma/GED required
- Bachelor degree preferred or relevant experience in lieu of degree
- Requires five years of business experience which must include two+ years of correspondence and/or telephone customer service experience
- Experience in claims processing necessary
- Ability to navigate the various claims and service operations systems
- Healthcare industry experience helpful
- Knowledge of HBCBSNJ complaints and appeals process preferred
- Knowledge of insurance claim and membership systems preferred
- Knowledge of medical terminology, COB, Medicare procedures preferred
- Knowledge of UCSW preferred
- Knowledge of Claims Policy guidelines preferred
- Knowledge of Microsoft Office Suite required
Benefits
- Comprehensive health benefits (Medical/Dental/Vision)
- Retirement Plans
- Generous PTO
- Incentive Plans
- Wellness Programs
- Paid Volunteer Time Off
- Tuition Reimbursement
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingnegotiationroot cause analysiseligibility verificationmedical terminologyCOBMedicare proceduresHBCBSNJ complaints and appeals processClaims Policy guidelinesUCSW
Soft Skills
customer servicenegotiation resolutionattention to detailwritten communicationinterpersonal skillsproblem-solvingtime managementaccuracyresearch skillsorganizational skills
Certifications
High School DiplomaGED