The Negotiation Specialist evaluates, negotiates, and settles workers' compensation claims while ensuring compliance with state laws and internal policies. They analyze medical documentation and collaborate with providers and adjusters to achieve cost-effective and fair claim resolutions.
The Manager leads a team to maintain provider relationships, ensure clinical quality standards, and drive network performance improvement. They serve as a clinical subject matter expert, overseeing quality initiatives and regulatory compliance while managing clinical and administrative staff.
The Customer Advocate manages claims and monitors case status by coordinating between network providers and referring adjusters. They are responsible for maintaining accurate case file data and ensuring compliance with HIPAA and URAC guidelines.
