Temporary No Surprises Act (NSA) Operations Specialist

At BCBSRI, our greatest resource is our people. We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

About the role

This temporary role provides operational support for No Surprises Act (NSA) processes, including open negotiation and independent dispute resolution activities. The role focuses on case tracking, documentation, and coordination to ensure timely and accurate processing during periods of increased volume.

Responsibilities

• Support NSA-related activities for Network Contracting.
• Maintain documentation and continuous tracking of cases specific to negotiations and offers for the Open Negotiation Notification and Independent Dispute Resolution (IDR) intake processes.
• Open Negotiation Notification (ONN)
  • Review and prepare offers during the open negotiation period.
• Independent Dispute Resolution (IDR)
  • Prepare dispute documentation (e.g., Qualifying Payment Amount rationale).
  • Work in collaboration with administrative staff to ensure IDR payments are submitted timely.
  • Work cross-functionally with GAU and Operations teams.
  • Identify cases that may not qualify and escalate for review.
  • Analyze dispute determinations.
  • Track key metrics (IDR volume, outcomes, turnaround time, financial impact).
  • Compile data and assist in reporting and analysis.

Requirements

• Two to four years of experience in health plan operations.
• Strong analytical, organizational, operational and communication skills.
• Ability to manage multiple priorities in a fast-paced, regulatory environment.
• Ability to organize work efficiently to meet established time and quality standards.
• Proficient in Excel.

Qualifications

• The Extras
  • Bachelor’s degree in Healthcare Administration, Business, Public Health, or related field.
  • Direct experience with the No Surprises Act, IDR, or out-of-network reimbursement.
  • Proficient in Outlook.

Benefits

• Flexible work arrangements that include remote and hybrid opportunities and paid time off.
• Tuition reimbursement and student-loan repayment assistance.
• Health, dental, and vision insurance.
• Programs that support mental health and well-being.
• Competitive pay, bonuses, and investment plans.
• Additional paid time to volunteer.
• Commitment to growing and developing employees.

Schedule

BCBSRI offers the following schedules, based on role:

• In-office: onsite 5 days per week.
• Hybrid: onsite 2-4 days per week.
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia.

Location

BCBSRI is headquartered in downtown Providence, conveniently located near the train station and bus terminal.