Legal Negotiator

Description The Legal Negotiator supports the Legal Department by managing claim negotiations, appeals, and related legal documentation. This role plays a critical part in resolving claims efficiently and ensuring compliance with applicable plan provisions, contracts, and regulations. The Legal Negotiator serves as a key liaison between internal teams and external stakeholders, utilizing strong negotiation, communication, and analytical skills to achieve timely and effective resolutions. Requirements Claims Negotiations & Appeals · 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. System & Documentation Management · 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. Stakeholder Communication · 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. Risk Mitigation & Compliance · 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. Collaboration & Process Improvement · 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 IDR process requirements is preferred