Technical Operator III
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Job Description
Negotiation Specialist evaluating and settling workers’ compensation claims. Reviewing medical bills, negotiating resolutions, and identifying cost savings for a remote claims operations team.
Responsibilities:
- Evaluate, negotiate, and settle workers’ compensation claims in compliance with applicable laws and internal policies
- Review and analyze 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 applicable state workers’ compensation laws and regulations
- Maintain accurate and up-to-date documentation of negotiations and outcomes in the claims management system
- Identify cost-saving opportunities and minimize claim exposure
- Communicate clearly and professionally with internal and external contacts
- Monitor claims for trends and report potential areas of concern
- Work closely with providers, adjusters, and internal teams
Requirements:
- 2–5 years of experience in workers’ compensation claims handling, bill review, or negotiation (or equivalent combination of education and experience)
- Strong knowledge of workers’ compensation regulations and fee schedules
- Strong understanding of medical billing codes (CPT, ICD-10, HCPCS), state fee schedules, and PPO discounts
- Excellent written and verbal communication and negotiation skills
- Strong attention to detail and ability to manage multiple cases independently
- Excellent analytical skills
- Ability to work independently and manage multiple priorities in a fast-paced environment
- Proficiency with claims management systems and Microsoft Office Suite
- Experience in a TPA, insurance carrier, or medical cost containment company preferred
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