About Daffodil
Out-of-network claim costs are one of the biggest drivers of health plan spend - and for too long, the tools available to negotiate and defend those costs have been fragmented, opaque, and built for a different era.
Daffodil is changing that. We're a Series A-stage healthcare technology company building a modern repricing and cost containment platform purpose-built for TPAs and self-funded health plans. Our platform gives plan administrators - and the specialists who support them - the data, workflows, and analytical firepower to price, defend, and negotiate out-of-network claims with confidence.
That means geographically-based Medicare and Fair Health benchmarking, QPA reference amounts for No Surprises Act compliance, real-time claim editing, and a negotiations workflow that keeps every interaction documented, defensible, and connected to the underlying data. We show our work - and we give our team the tools to explain it clearly to providers.
We're already live with TPAs and Payors who have grown tired of legacy vendors, revenue-share models, and platforms they don't control. We're growing fast, backed by forward-thinking investors, and building something the industry genuinely needs.
If you've spent years negotiating OON claims and have wanted better tools, better data, and a seat at the table to help shape how those tools are built - this is that opportunity.
What You'll Do
As an OON Negotiations Specialist, you will serve as the primary point of contact for healthcare providers regarding out-of-network post-payment claim inquiries and disputes. This role is responsible for clearly explaining reimbursement methodology using Medicare and market-based benchmarking data, articulating pricing determinations in a professional and defensible manner, and negotiating final settlement amounts on disputed claims when appropriate.
The ideal candidate is analytical, confident in conversation, skilled at navigating complex provider discussions, and excited by the opportunity to help shape the tools and workflows that support this work.
- Handle post-payment inquiries, disputes, and balance billing issues from healthcare providers' billing offices, revenue cycle teams, and practice managers for out-of-network claims
- Clearly explain pricing methodologies - including Medicare and Fair Health benchmarks and QPA reference amounts - to uphold savings for TPA clients and members in a professional and defensible manner
- Work directly with internal product and engineering teams to test new features, provide real-world feedback, and help build the tools and workflows you use every day
- Review disputed claims and supporting documentation to assess settlement opportunities and determine appropriate resolution strategies
- Negotiate settlements within defined parameters to resolve provider disputes efficiently and in alignment with plan objectives
- Document all interactions, rationale, and outcomes in internal systems with accuracy and completeness
- Collaborate with internal teams to align on negotiation thresholds, escalation paths, and strategies
- Maintain current knowledge of state-specific billing regulations, federal and state surprise billing laws including the No Surprises Act, and evolving industry trends
- Contribute to the continuous improvement of negotiation playbooks and provider communication strategies
What We're Looking For
- 5+ years in pre- or post-pay claim negotiation, settlement, or cost containment
- Strong understanding of out-of-network reimbursement methodologies; familiarity with ERISA plans, the No Surprises Act, and the IDR process
- Experience working with or on behalf of TPAs or self-funded health plans preferred
- Proven provider negotiation or conflict resolution skills
- Comfort working with data and benchmarking tools; ability to read, interpret, and communicate data-driven pricing rationale to a range of audiences
- Excellent verbal and written communication skills with the ability to explain complex reimbursement concepts clearly
- Ability to manage a full and varied caseload independently while maintaining professionalism and attention to detail
- Strong documentation and organizational skills
Why Join Daffodil
- The OON cost problem is real, it's large, and solving it well has meaningful downstream impact on employers, plan members, and the healthcare system as a whole - this role is at the center of that work
- You won't just fill a seat on a negotiations team - you'll help build what that team looks like, contribute to the tools they use, and influence how the work gets done
- Join a passionate, mission-driven team and work directly with experienced founders who are accessible and invested in your success
- Competitive compensation
