
Claims Dispute Resolution Specialist
3 days ago
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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