San Bernardino, CA · On-site
$33.50 - $39.50/hr
Description JOB SUMMARY The Provider Dispute Resolution Specialist is responsible for the accurate ... Experience with UB-04 and CMS-1500 claim forms. Ability to analyze complex data, identify ...
San Bernardino, CA · On-site
$33.50 - $39.50/hr
Description JOB SUMMARY The Provider Dispute Resolution Specialist is responsible for the accurate ... Experience with UB-04 and CMS-1500 claim forms. Ability to analyze complex data, identify ...
San Bernardino, CA · On-site
$33.50 - $39.50/hr
... claim forms. · Ability to analyze complex data, identify discrepancies, and apply contract terms accurately. · Strong written and verbal communication skills in English. · Effective time ...
San Bernardino, CA · On-site
$33.50 - $39.50/hr
... claim forms. · Ability to analyze complex data, identify discrepancies, and apply contract terms accurately. · Strong written and verbal communication skills in English. · Effective time ...
Analyze, manage and steward contracts, as needed (e.g., acreage and risk management, and compliance ... Negotiate and manage claim/dispute mitigation and resolution. Coordinate and/or determine land ...
Analyze, manage and steward contracts, as needed (e.g., acreage and risk management, and compliance ... Negotiate and manage claim/dispute mitigation and resolution. Coordinate and/or determine land ...
Analyze, manage and steward contracts, as needed (e.g., acreage and risk management, and compliance ... Negotiate and manage claim/dispute mitigation and resolution. Coordinate and/or determine land ...
Analyze, manage and steward contracts, as needed (e.g., acreage and risk management, and compliance ... Negotiate and manage claim/dispute mitigation and resolution. Coordinate and/or determine land ...
Submit and monitor card, ACH, and check adjustment or claim requests through applicable clearing ... Excellent analytical and investigative skills with strong attention to detail. * Ability to manage ...
Quick apply
Submit and monitor card, ACH, and check adjustment or claim requests through applicable clearing ... Excellent analytical and investigative skills with strong attention to detail. * Ability to manage ...
Submit and monitor card, ACH, and check adjustment or claim requests through applicable clearing ... Excellent analytical and investigative skills with strong attention to detail. * Ability to manage ...
Quick apply
Submit and monitor card, ACH, and check adjustment or claim requests through applicable clearing ... Excellent analytical and investigative skills with strong attention to detail. * Ability to manage ...
Dallas, TX · On-site
... claim dispute workflows, or IDR processes preferred. * Familiarity with commercial insurance payers, appeals, denials, and escalation management. * Strong analytical, organizational, and ...
Dallas, TX · On-site
... claim dispute workflows, or IDR processes preferred. * Familiarity with commercial insurance payers, appeals, denials, and escalation management. * Strong analytical, organizational, and ...
... claim dispute workflows, or IDR processes preferred. * Familiarity with commercial insurance payers, appeals, denials, and escalation management. * Strong analytical, organizational, and ...
... claim dispute workflows, or IDR processes preferred. * Familiarity with commercial insurance payers, appeals, denials, and escalation management. * Strong analytical, organizational, and ...
Parsippany, NJ · On-site
$65 - $70/hr
This position also provides assistance in resolving dispute resolution, weekly pay run activities ... Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state ...
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Parsippany, NJ · On-site
$65 - $70/hr
This position also provides assistance in resolving dispute resolution, weekly pay run activities ... Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company, state ...
IL · Remote
$34.60 - $39.40/hr
Maintain complete and accurate records of dispute research, determinations, correspondence, claim adjustments, recoveries, and related tracking activities. Analytics and Process Improvement * Develop ...
IL · Remote
$34.60 - $39.40/hr
Maintain complete and accurate records of dispute research, determinations, correspondence, claim adjustments, recoveries, and related tracking activities. Analytics and Process Improvement * Develop ...
Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state ... This position also provides assistance in resolving dispute resolution, weekly pay run activities ...
Quick apply
Prior Medicaid Claim processing experience with a Pharmaceutical and/or med Device company , state ... This position also provides assistance in resolving dispute resolution, weekly pay run activities ...
Parsippany, NJ · On-site
$50 - $70/hr
Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution ... This position also provides assistance in resolving dispute resolution, weekly pay run activities ...
Quick apply
Parsippany, NJ · On-site
$50 - $70/hr
Medicaid Claim processing function; manipulation of large datasets, negotiation/conflict resolution ... This position also provides assistance in resolving dispute resolution, weekly pay run activities ...
Plano, TX · On-site
... Dispute invalid claim resolutions to overturn declination and negotiate claim settlements Analyze data to determine claim validity; evaluate independent reports, including video, written incident ...
Plano, TX · On-site
... Dispute invalid claim resolutions to overturn declination and negotiate claim settlements Analyze data to determine claim validity; evaluate independent reports, including video, written incident ...
Chicago, IL · On-site
$34.60 - $39.40/hr
Maintain complete and accurate records of dispute research, determinations, correspondence, claim adjustments, recoveries, and related tracking activities. Analytics and Process Improvement * Develop ...
Chicago, IL · On-site
$34.60 - $39.40/hr
Maintain complete and accurate records of dispute research, determinations, correspondence, claim adjustments, recoveries, and related tracking activities. Analytics and Process Improvement * Develop ...
... dispute and/or fraudulent related activity on their credit card account. Takes appropriate action ... new claim(s), updating and follow-up on existing claim(s), and/or reviewing appeals on denied ...
... dispute and/or fraudulent related activity on their credit card account. Takes appropriate action ... new claim(s), updating and follow-up on existing claim(s), and/or reviewing appeals on denied ...
... and analyze claim inquiry data to determine root cause of errors to ensure contracts and ... Coordinates and hosts Management Level Provider Dispute meetings between internal management from ...
... and analyze claim inquiry data to determine root cause of errors to ensure contracts and ... Coordinates and hosts Management Level Provider Dispute meetings between internal management from ...
$85K - $112K/yr
Beyond standard claim management, you will handle formal appeals for denied claims, manage ... Accurately file dispute claims with third-party vendors and financial institutions, performing both ...
$85K - $112K/yr
Beyond standard claim management, you will handle formal appeals for denied claims, manage ... Accurately file dispute claims with third-party vendors and financial institutions, performing both ...
Westfield, IN · On-site
$22 - $24/hr
The Loss Claim Recovery Analysis Analyst is responsible for performing financial reconciliation on ... Provide detailed written explanation for decisioned losses in order to dispute financial impact
Westfield, IN · On-site
$22 - $24/hr
The Loss Claim Recovery Analysis Analyst is responsible for performing financial reconciliation on ... Provide detailed written explanation for decisioned losses in order to dispute financial impact
Westfield, IN · Remote
$22 - $24/hr
The Loss Claim Recovery Analysis Analyst is responsible for performing financial reconciliation on ... Provide detailed written explanation for decisioned losses in order to dispute financial impact
Westfield, IN · Remote
$22 - $24/hr
The Loss Claim Recovery Analysis Analyst is responsible for performing financial reconciliation on ... Provide detailed written explanation for decisioned losses in order to dispute financial impact
$19.25 - $25.50/hr
Do you have experience in QNXT -- specifically for claim adjustments? * Have you worked on provider ... Data Analytics Infrastructure & Cloud Solutions * Cyber Security Services We make reasonable ...
$19.25 - $25.50/hr
Do you have experience in QNXT -- specifically for claim adjustments? * Have you worked on provider ... Data Analytics Infrastructure & Cloud Solutions * Cyber Security Services We make reasonable ...
$16.59 - $19.27
4% of jobs
$19.27 - $21.96
12% of jobs
$22.50 is the 25th percentile. Wages below this are outliers.
$21.96 - $24.65
46% of jobs
$24.65 - $27.34
2% of jobs
$29.84 is the 75th percentile. Wages above this are outliers.
$27.34 - $30.03
12% of jobs
$30.03 - $32.71
0% of jobs
$32.71 - $35.40
11% of jobs
$35.40 - $38.09
6% of jobs
$38.09 - $40.78
3% of jobs
$40.78 - $43.47
2% of jobs
$43.47 - $46.15
2% of jobs
$16
$27
$46
For Claim Dispute Analyst jobs, the most frequently searched job titles are:
San Bernardino, CA • On-site
$33.50 - $39.50/hr
Full-time
Re-posted 17 days ago
Description
JOB SUMMARY
The Provider Dispute Resolution Specialist is responsible for the accurate, timely, and compliant review and resolution of provider disputes and appeals related to claims adjudication, reimbursement, coding, and authorization determinations. This role ensures compliance with applicable California state and federal regulations, contractual obligations, and internal policies while supporting positive provider relations.
Requirements
MINIMUM & PREFERRED QUALIFICATIONS
Education/Training
Minimum: High school diploma or equivalent.
Preferred: Coursework or training in healthcare administration, medical billing, or related field.
Experience
Minimum: 5+ years of experience processing managed care health claims.
Preferred: 2+ years of direct Provider Dispute Resolution and/or Appeals experience within Medicare, Medi-Cal/Medicaid, Commercial, PPO, and/or HMO environments.
Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.
Skills, Knowledge & Abilities
Strong working knowledge of managed care claims operations and regulatory requirements, including dispute and appeal timeliness standards.
Proficiency with medical coding concepts (ICD-10, CPT, HCPCS, DRG, ASC).
Experience with UB-04 and CMS-1500 claim forms.
Ability to analyze complex data, identify discrepancies, and apply contract terms accurately.
Strong written and verbal communication skills in English.
Effective time management skills with the ability to manage competing priorities and workload volumes.
Intermediate proficiency with Microsoft Office applications, including Word and Excel.
Demonstrated problem-solving skills and attention to detail.
PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS
The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. This position primarily involves sedentary work with routine use of a computer and standard office equipment. The role may require occasional light physical activity (up to 10 pounds) and brief periods of bending, reaching, or filing. The employee must be able to maintain concentration for extended periods, analyze detailed information, and meet regulatory deadlines, with or without reasonable accommodation.
PAY RANGE
$33.50 - $39.50 / hourly
