Claims Negotiation Manager
$66,330–$145,860 year
On-siteDenver, Colorado, United States
Job Summary
Lead the strategy, operations, and performance of the claims negotiation team supporting No Surprises Act (NSA) claims and elective out-of-network reimbursement negotiations. Serve as the subject matter expert on out-of-network reimbursement methodologies and NSA regulations, providing strategic guidance while partnering with Product, Operations, Compliance, and Client teams to enhance negotiation strategies and drive operational excellence. Monitor team performance, coach negotiators, analyze outcomes and market trends, and identify process improvements to foster strong provider relationships and achieve financial savings. This full-time role requires 40 weekly hours and is eligible for a bonus, commission, or short-term incentive program. The position offers a comprehensive benefits package including medical, dental, and vision coverage, paid time off, and retirement savings options.
Required Qualifications
- 5+ years of healthcare claims, reimbursement, provider contracting, network management, or negotiation experience
- 2+ years of leadership experience managing teams and operational performance
- Demonstrated expertise in the No Surprises Act (NSA), out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication, with the ability to interpret complex regulations, evaluate claim and reimbursement disputes, guide negotiation strategies, ensure compliance, and drive favorable financial and operational outcomes
- 2+ years of experience working with payers, providers, healthcare networks, or managed care organizations
- Demonstrated ability to lead cross-functional initiatives and support product development efforts
- Strong analytical, communication, negotiation, and problem-solving skills
- Proficiency in interpreting claims data, performance metrics, and reimbursement trends
- Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word, and Outlook)
- Bachelor's degree or equivalent combination of education and healthcare industry experience
Desired Qualifications
- Experience working with Centers for Medicare & Medicaid Services (CMS) regulations, reimbursement guidelines, and healthcare compliance requirements
- Knowledge of the No Surprises Act (NSA) and out of network reimbursement methodologies
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