Claims ReviewerArbitrator - 1099 Remote

Capitol Bridge is actively seeking an experienced 1099 Claims Reviewer/Arbitrator. The Claim Dispute Resolution Specialist will play a crucial role in the Florida Statewide Health Plan Claim Dispute Resolution Program under the Agency for Health Care Administration. This position is integral to ensuring fair and efficient resolution of claim disputes.

You will be responsible for resolving claim disputes submitted by various parties such as physicians, hospitals, institutions, pharmacies, and other licensed healthcare providers. Additionally, you will handle disputes from Health Maintenance Organizations (HMOs), Primary Health Care centers (PHCs), Exclusive Provider Organizations (EPOs), Prepaid Health Plans (PHPs), major medical expense health insurance policies offered by both groups and individual health insurers, and Preferred Provider Organizations (PPOs). Your role requires conducting all job duties efficiently, promptly, productively, consistently, and courteously, while maintaining a high level of professionalism.

Salary Range:$125 per case, with an estimated duration of one (1) hour or less per case review.

Key Responsibilities:

• Conduct impartial assessment of documentation from both initiating and responding parties.
• Adhere to company policies, state regulations, and specific project guidelines.
• Maintain effective communication by participating in necessary meetings.
• Ensure timely completion of arbitrations within assigned deadlines.
• Follow established QA/QC processes and meet company/departmental standards.
• Engage in required training, team meetings, and review of internal and external communications.
• Uphold scheduling commitments and privacy regulations.
• Fulfill additional training requirements as needed.
• Perform other related duties as directed by leadership.

Required Qualification:

• A program integrity related professional certification is required, such as Certified Compliance and Ethics Professional (CCEP), Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), Certified Financial Crimes Investigator (CFCI), or Certified Insurance Fraud Investigator (CIFI).
• Qualification Requirements:
• Demonstrated expertise in arbitration.
• Attorneys are encouraged to apply.
• Specialized experience in arbitration and claims administration within healthcare services.
• Exceptional skills in managing sensitive and confidential information.
• Strong organizational abilities, written, and verbal communication skills in English.
• A Bachelor’s degree (BA/BS) is essential; Juris Doctorate degree is highly desirable.
• Ability to work both independently and collaboratively.
• Skilled in prioritizing tasks to align with business needs and assignments.

About Capitol Bridge
Founded in 2012, Capitol Bridge is based in Arlington, Virginia, a business with proven expertise providing independent medical reviews, records/data management services, medical coding, administrative staffing, and eligibility reviews.

Required Screenings

You will receive a request for a background check regarding this employment opportunity. Employment is contingent on successful passing of a background check.

Reasonable Accommodation

If you require alternative methods of application or screening, you must approach the employer directly to request this. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions. Other duties may be assigned.

EEO Statement

Capitol Bridge LLC. is an Equal Opportunity Employer. All employment decisions at Capitol Bridge are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Texting Notice

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