Legal Negotiator

Overview

This role supports the Legal Department by managing claim negotiations, appeals, and related legal documentation. The position is essential for resolving claims efficiently while ensuring compliance with plan provisions, contracts, and regulations. It acts as a liaison between internal teams and external stakeholders, requiring strong negotiation, communication, and analytical skills to achieve timely and effective resolutions.

Responsibilities

• Review claim information, supporting documentation, and system data to evaluate appropriate settlement strategies.
• Prepare, present, and negotiate settlement offers with clients, providers, and third-party collection entities.
• Manage appeals through resolution, ensuring adherence to internal procedures and applicable regulations.
• Exercise strong judgment when resolving complex or escalated claims and identify matters requiring further legal review.
• Maintain accurate, thorough, and timely documentation of negotiations, communications, and outcomes within internal systems.
• Utilize system functionality to track claim status, deadlines, and resolution metrics.
• Communicate professionally and effectively with internal departments and external stakeholders regarding claim status, settlement offers, and resolution timelines.
• Provide timely follow-ups and clear explanations to ensure transparency and manage expectations throughout the negotiation process.
• Ensure negotiation strategies and resolutions align with contractual obligations, and applicable laws and regulations.
• Identify trends, recurring issues, or potential risks related to claims and escalate concerns to Legal leadership as appropriate.
• Collaborate with Legal, Operations, Client Services, and other internal teams to support efficient workflows and positive client outcomes.
• Contribute to the development and refinement of templates, procedures, and best practices related to claims negotiations and appeal resolution.

Skills & Abilities

• Strong negotiation, problem-solving, and conflict-resolution skills.
• Exceptional interpersonal and customer service skills.
• Clear, professional written and verbal communication skills.
• Excellent organizational skills with strong attention to detail.
• Effective time management and ability to prioritize competing deadlines.
• Ability to analyze complex claim data and apply plan language accurately.
• Proficiency with claim documentation systems.
• Ability to work independently while contributing to a collaborative, team-based environment.
• Ability to type at least 60 words per minute.
• Demonstrated discretion and ability to handle confidential information.

Education & Experience

• Bachelor’s degree required.
• Minimum of two to five (2–5) years of experience in legal, paralegal, claims, or healthcare-related roles preferred.
• Experience with settlement negotiations, claims resolution, or appeals strongly preferred.
• Experience applying ERISA and ACA requirements in claim reviews, appeals management, and settlement negotiations is preferred.
• Experience or working knowledge of the No Surprises Act, including its application to negotiation and Independent Dispute Resolution (IDR) process requirements, is preferred.