Curative - Monrovia, CA
posted 18 days ago
Full-time
Monrovia, CA
Personal and Laundry Services
About the position
The Claims Specialist at Curative Health Plan plays a crucial role in managing and resolving healthcare claims, particularly in relation to the No Surprises Act. This position is designed to combat rising healthcare costs by providing innovative solutions and services to health plans. The specialist will be responsible for reviewing medical claims, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution, while also supporting the team with balance billing and overpayment matters. The ideal candidate will thrive in a fast-paced environment and possess strong communication skills.
Responsibilities
- Manage a daily running inventory of unpaid claims or claim disputes.
- Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards.
- Contact facilities and providers to discuss charge adjustments and rationale.
- Contact facilities and explain benefits to resolve payment disputes.
- Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities.
- Capture detailed notes on calls for future reference.
- Handle member inquiries in accordance with their medical plan as needed.
- Work with Curative's legal department to ensure escalation of claims.
- Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process.
- Handle confidential information in accordance with HIPAA.
Requirements
- Baccalaureate degree (BA/BS) from an accredited college or university (preferred).
- Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting (preferred).
- Computer literate, including Google Workspace products.
- Looker software experience is a plus.
