Arbitration Claims Specialist
About The Position
The Arbitration Claims Specialist supports ClearHealth Strategies’ Independent Dispute Resolution (IDR) team in a quasi-legal process involving dispute review, eligibility analysis, and preparation of arbitration briefs. The role helps ensure compliance with the federal No Surprises Act and state surprise billing laws. It is a full-time, 40-hour-per-week position, Monday through Friday, with flexible scheduling across eight-hour shifts during normal business hours of 8:00 a.m. to 5:00 p.m. based on the employee’s local time zone. Occasional overtime may be necessary. This is a national remote position. Employees may telecommute from anywhere in the United States, subject to remote-work requirements, including maintaining a secure, private work area and having an approved high-speed internet connection. The role involves responding to inquiries from CMS, arbiters, providers, clients, and management; analyzing claims and supporting documentation; resolving issues; and escalating complex matters when appropriate.
Requirements
- High school diploma/GED or equivalent work experience.
- Must be at least 18 years of age.
- At least 1 year of experience preparing written summaries, case reviews, reports, or briefs in a regulated, compliance-driven, or legal-adjacent environment.
- At least 1 year of experience reviewing and interpreting claims data, Explanation of Benefits, and supporting documentation to identify issues and determine appropriate next steps.
- Experience ensuring compliance with HIPAA privacy and security regulations.
- Ability to work full-time between 8:00 a.m. and 5:00 p.m. local time, with flexibility to work occasional overtime as business needs require.
- Ability to keep company-sensitive documents secure, if applicable.
- Ability to establish a dedicated work area separated from other living areas that provides information privacy.
- Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or have existing high-speed internet service.
- Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Nice To Haves
- At least 1 year of experience working with the federal No Surprises Act and/or state surprise billing disputes.
- Experience supporting or working within personal injury litigation.
- Knowledge of the medical claims process.
Responsibilities
- Prepare arbitration briefs.
- Respond to inquiries from CMS, arbiters, providers, clients, and ClearHealth management.
- Identify issues, analyze Explanation of Benefits (EOBs) and claim information, apply critical thinking to formulate a plan of action, and resolve issues independently.
- Triage complex issues to management.
- Manage multiple priorities in a time-sensitive manner.
- Work in a fast-paced, high-volume environment with quick turnaround times.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase plan.
- 401(k) contribution.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
