Claims Negotiation Manager

This is a fully remote position, open to applicants in California, +2 more states.

📋 Description

• Direct the strategy, operations, and performance of the claims negotiation team that handles No Surprises Act claims and elective out-of-network reimbursement negotiations.

• Supervise negotiators dedicated to achieving fair, compliant, and cost-effective resolutions for claims.

• Act as a subject matter expert in out-of-network reimbursement methodologies, No Surprises Act regulations, and best practices for negotiation.

• Offer strategic direction throughout the organization.

• Lead daily negotiation operations in collaboration with Product, Operations, Compliance, Analytics, and Client teams.

• Improve negotiation strategies and assist in product development.

• Promote operational excellence and adherence to federal and state regulations.

• Assess team performance while coaching and developing negotiation talent.

• Examine negotiation results and market trends.

• Identify opportunities for process enhancements and shape negotiation products and services.

• Generate measurable financial savings while fostering relationships and engagement with providers.

• Contribute to business expansion and organizational goals.

⛳️ Requirements

• A minimum of 5 years experience in healthcare claims, reimbursement, provider contracting, network management, or negotiation.

• At least 2 years of leadership experience overseeing teams and operational performance.

• In-depth knowledge of the No Surprises Act, out-of-network reimbursement methodologies, provider billing practices, and healthcare claims adjudication.

• Capability to interpret complex regulations and assess claim and reimbursement disputes.

• Proficiency in guiding negotiation strategies, ensuring compliance, and achieving favorable financial and operational results.

• A minimum of 2 years of experience interacting with payers, providers, healthcare networks, or managed care organizations.

• Ability to lead cross-functional projects and support product development initiatives.

• Strong analytical, communication, negotiation, and problem-solving abilities.

• Proficient in analyzing claims data, performance metrics, and reimbursement trends.

• Competent in Microsoft Office Suite, including Excel, PowerPoint, Word, and Outlook.

• Bachelor's degree or an equivalent blend of education and experience in the healthcare sector.

• Preferred: Experience with CMS regulations, reimbursement guidelines, and healthcare compliance standards.

• Preferred: Knowledge of the No Surprises Act and out-of-network reimbursement methodologies.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources that support physical, emotional, and financial well-being, based on eligibility.