Job Description: Paralegal - Dispute Resolution Program

Employment Type: Full-time Location Type: Remote Salary: Competitive

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Position Overview

Dane Street is seeking highly motivated Paralegals with healthcare claims experience to join a new dispute resolution program. This role is ideal for individuals with backgrounds as paralegals, claims resolution managers, or administrative law judges who possess expertise in healthcare claims. The program offers an exciting work environment, competitive compensation, and strong growth potential.

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Job Summary

In this role, you will leverage your organizational knowledge to review reports accompanying medical records within the group health sector. Your primary responsibility will be to ensure the accuracy of medical billing information and coding. You will collaborate with other reviewers and their office teams to ensure clarity of information, address all queries, and guarantee that reports are submitted within client deadlines.

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Core Duties & Responsibilities

• Evaluates and organizes medical information to ensure proper case adjudication.
• Determines if cases meet all established program standards.
• Ensures medical records are appropriately matched with documentation, obtaining correct documentation when necessary.
• Participates in training, which may include arbitration training.
• Reviews policy guidelines and delineates when criteria are met or not met.
• Evaluates claims for conflict of interest and appropriateness.
• Works within established timeframes defined by program parameters.
• Provides strong customer service, working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance of cases.
• Provides oversight for complex cases requiring additional review before client submission.
• Serves as an additional level of QA and clinical knowledge/review for cases with quality issues.

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Requirements

Required Education & Experience:

• 3-5 years of experience as a paralegal in a law firm, health care firm, or entity processing disputed claims.
• Arbitration experience is strongly preferred.
• Experience working remotely is preferred.
• Experience with medical office or hospital claims services is preferred.
• A medical office or health care background is a plus.

Required Skills:

• Must work with a sense of urgency and meet deadlines.
• Must be self-motivated with a strong drive for performance excellence.
• Excellent written and verbal communication skills are required.
• Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc., is a plus).
• Attention to detail is REQUIRED.

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About Dane Street

Dane Street is a fast-paced, Inc. 500 Company with a high-performance culture, seeking insightful, astute, and forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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Benefits

We offer generous Paid Time Off, an excellent benefits package, and a competitive salary.

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PLEASE BE AWARE: In the interest of the security of both parties, Dane Street will never conduct an interview via text or request checks from candidates for purchasing equipment.