Dispute Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Investigate and address first-level disputes related to claim payments, claim denials, and contractual agreements.

• Review claim records and forms while adhering to set quality and production standards.

• Prepare acknowledgment and determination letters.

• Provide comprehensive notes on decisions made regarding disputes and the rationale behind them.

• Draft correspondence for the Senior Examiner.

• Collaborate with leadership to address improper processing trends and claim-related issues.

• Foster positive relationships with team members, interdepartmental staff, and leadership.

• Stay informed about claim processing guidelines, procedures, regulations, and compliance requirements.

• Assist with the data entry of incoming clean claims as required.

• Educate providers on proper processing to enhance provider satisfaction.

⛳️ Requirements

• High school diploma or equivalent; relevant professional experience may be considered in lieu of education.

• Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing setting.

• At least three (3) years of experience in health plan claims processing.

• A minimum of two (2) years in health plan claims dispute experience, focusing on analyzing and resolving provider claims.

• Proficient in computer applications and software, including Excel, Outlook, PowerPoint, Word, Teams, and job-specific systems.

• Ability to navigate state and federal websites as well as medical billing guidelines.

• Exceptional verbal and written communication abilities.

• Strong organizational and time management capabilities.

• Proficient problem-solving and decision-making skills.

• Proof of COVID-19 vaccination or a declination form is required prior to employment.

🏝️ Benefits

• Medical insurance coverage (Medical, Dental, Vision).

• 17 days of personal time off (PTO).

• 12 holidays observed each year.

• Sick leave.

• 401K savings plan with matching contributions.

• Opportunities for advancement.

• Additional benefits.

• Compliance with COVID-19 vaccination policy, requiring proof of vaccination or a declination form before employment.

• Standards for infection control and personal protective equipment (PPE).