Claims Dispute Resolution Specialist

3 days ago


Makati City, National Capital Region, Philippines beBeeDispute Full time ₱25,000 - ₱30,000

Job Overview:

This role entails reviewing and resolving provider disputes in accordance with regulatory requirements and internal policies.

Key Responsibilities:

  • Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims.
  • Analyze claims history, adjudication data, and notes using EZCap.
  • Interpret health plan policies, provider contracts, and regulatory requirements.
  • Document findings and resolutions according to compliance standards.
  • Collaborate with internal teams to ensure timely dispute resolution.

Requirements:

  • Proficiency in Microsoft Office applications.
  • A high school diploma or equivalent is required; an associate or bachelor's degree is preferred.
  • 1–2 years of experience in provider dispute resolution in healthcare, TPA, or health plan settings.
  • Familiarity with Medi-Cal and Commercial insurance claims.
  • Strong analytical and problem-solving skills.
  • Excellent verbal and written communication skills.
  • Attention to detail in documentation and compliance.


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