Legal Negotiator

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. 

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