Member Advocate - Negotiator

00. Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be willing and able to work onsite minimum 4 times per week in our Melbourne, FL office.

The Mission At Christian Care Ministry we believe that Christians can, and should, share in one another’s burdens. Through the use of Medi-Share® , a healthcare sharing ministry for Christians, we cultivate that belief. To that end, our Mission Statement is as follows: Connecting people to a Christ-centered community wellness experience based on faith, prayer, and personal responsibility.

The Team Everyone at Christian Care Ministry is in agreement with our Statement of Faith, which outlines our core beliefs. Although we aren’t perfect people, we are serving our perfect God and our Members to the best of our ability. The Job The Member Advocate Negotiator works in close partnership with the Member Bill Advocate to resolve balance bills by engaging and negotiating directly with the provider or facility that issued the bill to the member.

The Negotiator applies knowledge of Medicare reimbursement rates, market benchmarks, payer-provider fee schedules to anchor and advance negotiations toward a settlement that protects the member from unexpected out-of-network charges. The role owns the full negotiation lifecycle from case assignment through settlement execution and case closure. At lower activation scenarios, the Negotiator’s significant spare capacity supports provider contracting and network analytics.

Responsibilities

Collaboration with the Member Advocate Receive balance-bill cases from the Member Advocate following intake, eligibility verification, and pathway determination; review the case file for completeness before initiating negotiation Coordinate with the assigned Member Advocate on member context, prior provider communications, and any sensitivities that should shape negotiation tone or approach Provide settlement updates and projected closure timeline to the Member Advocate on a defined cadence so the Advocate can keep the member informed within SLA windows Hand back to the Member Advocate at settlement for member confirmation, CSAT capture, and case closure in the case management system Negotiation Strategy Preparation Research Medicare, market benchmarks, and applicable fee schedules to develop negotiation strategy and opening offers for each case Review provider claims for CPT/ICD coding accuracy, and billing reasonableness prior to negotiation; flag suspected coding errors or upcoding for Paralegal review when warranted Prepare a documented negotiation plan for each case identifying opening offer, target range, walk-away threshold, and supporting evidence Direct Provider Engagement Settlement Conduct direct payment negotiations with the provider or facility that issued the balance bill to the member, on the member’s behalf Manage the full negotiation lifecycle: provider outreach, counter-offer cycles, settlement execution, and case closure Operate within Negotiator-defined settlement authority thresholds; obtain Advocacy Team Manager authorization for settlement parameters that exceed those thresholds Where the case has been routed through delegation, partner with the delegated team or assume internal handling per the established hand-off criteria; ensure no duplicative provider outreach Documentation Case Management Document all negotiation activity, communications, and settlement terms in the case management system in real time and to audit-ready standards Maintain accurate, current case status so that the Member Advocate, Manager, and any delegated vendor can rely on a single source of truth for the case Cross-Team Coordination Escalation Collaborate with paralegals on legal case file preparation for complex, high-dollar, or multi-party negotiations Escalate unresolvable cases to the Advocacy Team