Legal Negotiator

Responsibilities

• Evaluate appropriate settlement strategies based on claim information, supporting documentation, and system data.
• Prepare, present, and negotiate settlement offers with clients, providers, and third-party collection entities.
• Manage appeals through resolution, ensuring adherence to internal procedures and applicable regulations.
• Exercise strong judgment when resolving complex or escalated claims and identify matters requiring further legal review.
• Maintain accurate, thorough, and timely documentation of negotiations, communications, and outcomes within internal systems.
• Utilize system functionality to track claim status, deadlines, and resolution metrics.
• Communicate professionally and effectively with internal departments and external stakeholders regarding claim status, settlement offers, and resolution timelines.
• Provide timely follow-ups and clear explanations to ensure transparency and manage expectations throughout the negotiation process.
• Ensure negotiation strategies and resolutions align with contractual obligations and applicable laws and regulations.
• Identify trends, recurring issues, or potential risks related to claims and escalate concerns to Legal leadership as appropriate.
• Collaborate with Legal, Operations, Client Services, and other internal teams to support efficient workflows and positive client outcomes.
• Contribute to the development and refinement of templates, procedures, and best practices related to claims negotiations and appeal resolution.

Requirements

• Minimum of two to five (2–5) years of experience in legal, paralegal, claims, or healthcare-related roles preferred.
• Experience with settlement negotiations, claims resolution, or appeals strongly preferred.
• Experience applying ERISA and ACA requirements in claim reviews, appeals management and settlement negotiations is preferred.
• Experience or working knowledge of the No Surprises Act, including its application to negotiation and IDR process requirements is preferred.