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Medical Claims Specialist (Monday - Friday 9am-3pm)

Company: MultiPlan Inc.
Location: Irving
Posted on: June 7, 2021

Job Description:

Job Description

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

As a Medical Claims Resolution Specialist::

  • You will have a steady Monday through Friday 30 hour per week schedule 9:00 am to 3:00 pm.
  • Currently, this position is a remote or, work from home, position but will be located in our Irving, TX office when it reopens.
  • Earn $16.83 per hour and have the opportunity to receive additional quarterly bonuses based on performance after completion of the training period.
  • We provide an excellent paid classroom training program as well as continuous on the job coaching and mentoring. We also have advancement and growth opportunities available to employees.
  • Find more information on what it's like to be a MultiPlan employee on our Careers page at [ Link Removed ]

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.

  14. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.


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.

Job Requirements

  • 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
  • Ability 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


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 (low copay & deductible)
  • Life insurance
  • Short- and long-term disability
  • 401(k) + match
  • Generous Paid Time Off
  • Paid company holidays
  • Tuition reimbursement
  • Flexible Spending Account
  • Employee Assistance Program
  • Summer Hours


MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please [ Link Removed ]

Keywords: MultiPlan Inc., Irving , Medical Claims Specialist (Monday - Friday 9am-3pm), Other , Irving, Texas

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