Overview
Remote
Depends on Experience
Full Time
Accepts corp to corp applications
No Travel Required
Unable to Provide Sponsorship
Skills
Billing
Claims Management
Insurance
Compensation Management
Analytical Skill
Attention To Detail
Communication
Cost Control
Documentation
HCPCS
ICD-10
LPN
PPO
Regulatory Compliance
Reporting
LVN
Management
Medical Billing
Microsoft Office
Negotiations
Nursing
Job Details
Job Title: Negotiator 4
Reports To: IQ Analysis Manager
Location: Remote
Job Type: Full-Time
Summary:
The Negotiator 4 is responsible for evaluating, negotiating, and settling workers
compensation claims in compliance with applicable laws and internal policies. This role
involves working closely with providers, adjusters, and internal teams to ensure cost-
effective and fair outcomes while maintaining a high standard of service.
Key Responsibilities:
Review, analyze, and interpret medical bills, treatment records, and claim
documentation to determine appropriate settlement values.
Negotiate with medical providers, and other parties to reach fair and timely
resolutions.
Ensure compliance with all applicable state workers compensation laws and
regulations.
Maintain accurate and up-to-date documentation of negotiations and outcomes in
the claims management system.
Identify potential cost-saving opportunities and work toward minimizing claim
exposure.
Communicate clearly and professionally with both internal and external contacts.
Monitor claims to identify trends and report on potential areas of concern.
Qualifications:
4-7 years of experience in workers compensation claims handling, bill review, or
negotiation (or equivalent combination of education and experience).
Coding certification (CPC or CCS) or Nursing license (RN, CAN, LPN, LVN or
like)
Strong knowledge of workers compensation regulations and fee schedules.
Full understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee
schedules, and PPO discounts
Excellent communication and negotiation skills, both written and verbal
Strong attention to detail and ability to manage multiple cases independently
Excellent negotiation, communication, and analytical skills.
Ability to work independently and manage multiple priorities in a fast-paced
environment.
Proficient with claims management systems and Microsoft Office Suite.
Preferred Qualifications:
Experience in a TPA, insurance carrier, or medical cost containment company.
Anam Chaudhry
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.