Medical Claims Negotiator

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We're seeking a Medical Claims Negotiation Expert who thrives in high-stakes conversations and knows how to turn complex claims into efficient, fair settlements. The Role: We are looking for an experienced professional to lead negotiations with hospitals, facilities, and provider systems to resolve outstanding claims and secure savings for self-funded clients. This role is ideal for someone with a deep understanding of the claims lifecycle, a firm grasp of reference-based pricing (RBP), and a strategic mindset for batch/volume settlements by provider. Responsibilities: Negotiate directly with hospitals, provider groups, and facilities to settle high-dollar and grouped claims. Analyze historical claims data and reprice using RBP methodologies to support negotiations. Coordinate settlements involving bundled/grouped claims for large provider systems. Collaborate with internal audit and legal teams to apply findings from retro reviews. Maintain documentation and reporting on negotiation outcomes and trends. Serve as a strategic advisor on pricing benchmarks and dispute resolution. Qualifications: Minimum 3–5 years of experience in healthcare claims negotiation, with a focus on hospital and facility billing. Proven success in settling grouped claims and managing large provider relationships. Strong working knowledge of Reference-Based Pricing (RBP) as a negotiation strategy. Familiarity with Medicare pricing benchmarks and commercial-to-Medicare ratio modeling. Excellent communication, documentation, and relationship-building skills.

Keyword: Customer Service

Price: $10.0

Science & Medicine English Medical Billing & Coding