This role is primarily responsible for arbitrating/deciding payment disputes
The arbiter must remain neutral when analyzing the materials provided, and must be able to write a concise determination in a short period of time to meet deadlines
Review cases to determine and summarize facts of each case assigned and assess issues involved in the case
Research issues using federal law, federal regulations, relevant contract law
Review plan contracts and other relevant information; make a decision as to whether an enrollee is entitled to benefits in cases involving contractual disputes
Communicate the determination in a clearly written format
Exercise independent judgment to ensure determination is accurate, well supported and defensible; take appropriate action as required
Acquire all necessary information involving cases and render final determination based on the information provided by the appellant
Manage highly complex case files
Perform other duties as may be assigned by management
Draft and review payment determination decisions
Draft email responses to payment dispute questions or concerns from the disputing parties
Interpret applicable regulations and policies associated with case to determine recommendation
Ensure solutions are consistent with organizational objectives

Juris Doctorate preferred
Ability to perform comfortably in a fast-paced, deadline-orientated work environment
Excellent organizational, interpersonal, written, and communication skills
Ability to work as a team member, as well as independently
Work across multiple systems, such as SharePoint, Salesforce, and Microsoft Office products

The NAI

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