Medical Claims Resolution Specialist (Entry level)

MultiPlan Inc. Irving, TX
Come join our Out of Network Negotiation Services team at MultiPlan! Founded in 1980, we are the industry's most comprehensive provider of healthcare cost management solutions. We have almost 900,000 healthcare providers under contract, an estimated 68 million consumers accessing our network products, and 40 million claims reduced through our network and non-network solutions each year.

JOB SUMMARY: This position is responsible for negotiating small dollar claims including retrospective and concurrent claims on behalf of payor to achieve maximum discount from bill amount prior to payment.


1. Maximize savings opportunities on each claim within the established department and individual goals by contacting provider on all assigned claims and presenting a proposal while maintaining high quality standards.

2. Initiate provider telephone calls as often required with respect to proposals and respond to providers following receipt of proposal. Includes follow up phone calls on system automated communications to providers.

3. Address counter-offers received and present proposal for resolution while adhering to client guidelines and department goals.

4. Provide education to providers on online services available for proposal review and approval.

5. Process claims agreements in database and close out claims; including updating provider data base for reference and claims processing on subsequent claims.

6. Identify and seek opportunities to establish ongoing global or concurrent agreements for future claims.

7. Identify and seek opportunities with previously challenging providers to achieve savings.

8. Handle post claim closure inquires, including payment status and defending original agreements terms.

9. May require ACD phone responsibilities and tracking outcomes.

10. Collaborate, coordinate, and communicate across disciplines and departments.

11. Ensure compliance with HIPAA regulations and requirements.

12. Demonstrate Company's Core Competencies and values held within.

13. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.


The incumbent adheres to company policies and customer specific procedures to meet control standards. An incumbent relies on established instructions and procedures, applies basic skills and may develop advanced skills using tools and equipment appropriate for the position. Duties and tasks are standardized and generally contain written instructions, allowing an incumbent to resolve routine questions and problems, and referring more complex issues to a higher level. Work is subject to defined work output standards and involves high volume claims resolution. Work involves direct contact with internal and external customers.

* Minimum high school diploma or GED

* Minimum 6 months experience in the health care industry (provider billing, provider collections, insurance or managed care); 1 year preferred

* Required licensures, professional certifications, and/or Board certifications as applicable

* Knowledge of medical coding desired

* Knowledge of applicable laws and statutes (state, local or federal) for positions focusing on Workers' Compensation or automobile medical ("auto") bills.

* Knowledge of commonly used medical data resources desired

* Knowledge of general office operations and/or experience with standard medical insurance claim forms

* Communication (verbal, written and listening) and organizational skills

* Negotiation skills preferred

* Abililty to provide attention to detail to ensure accuracy including mathematical calculations

* Ability to provide a level of customer service within established standards

* Ability to identify issues and determine appropriate course of action for resolution

* Ability to display professionalism by having a positive demeanor, proper telephone etiquette and using proper language and tone.

* Ability to use software and hardware related to job responsibilities, including MS Word and MS Excel spreadsheets and database software

* Ability to adjust/alter workflow to meet deadlines in a fast-paced environment

* Ability to work independently and handle confidential information

* Ability to process verbal and written instructions

* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone

As a Medical Claims Resolution Specialist with MultiPlan, you will be part of an organization with a proud 30-year legacy of experience and growth. We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

* Medical, dental, and vision coverage

* Life insurance

* Optional and dependent life insurance

* Short- and long-term disability

* 401(k) employer matching

* Paid time off (earn 20 days per year)

* Paid company holidays

* Floating holiday

* Tuition reimbursement

* Flexible Spending Account

* Employee Assistance Program

Summer hours = Memorial Day to Labor day we get off two hours early EVERY FRIDAY!!

Opportunity. Recognition. Satisfaction. Grow your career with MultiPlan!


As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law.