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Provider Claim Dispute Analyst Jobs (NOW HIRING)

UW Credit Union

Dispute Specialist I

Madison, WI · On-site

$28.03/hr

Collaborate with Dispute Specialist team to identify current trends and analyze claim outcomes to ... Provide direct phone and e-mail support to members, MS&S, MSC and other internal partners ...

Zing Health

Senior Provider Claims Dispute Specialist

IL · Remote

$34.60 - $39.40/hr

... claim adjustments and overpayment recoveries, conducts root cause and financial impact analyses ... Complex Provider Dispute Resolution * Independently investigate and resolve escalated, high-dollar ...

Zing Health Holdings Inc

IL · On-site

$34.60 - $39.40/hr

... claim adjustments and overpayment recoveries, conducts root cause and financial impact analyses ... Complex Provider Dispute Resolution * Independently investigate and resolve escalated, high-dollar ...

Fifth Third

Dispute Intake Analyst

Grand Rapids, MI · On-site

Under general supervision, the Dispute Intake Analyst provides outstanding customer service while capturing accurate customer account and transaction information. The Dispute Intake Analyst plays a ...

InterSources

Provider Dispute Coder

$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 ...

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Provider Claim Dispute Analyst information

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How much do provider claim dispute analyst jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for provider claim dispute analyst in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

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For Provider Claim Dispute Analyst jobs, the most frequently searched job titles are:

PROVIDER DISPUTE RESOLUTION SPECIALIST

Burlingame, CA • On-site

NORTH EAST MEDICAL SERVICES
Health Care and Social Assistance • 51 - 200 employees
Learn more about NORTH EAST MEDICAL SERVICESexternal

$42.79 - $48.75/hr

Full-time

Medical, Dental, Vision, Retirement

Re-posted 6 days ago

Job description

The MSO department seeks a PDR Specialist with strong verbal and written communication skills to handle provider disputes and appeals related to claims payments. This role involves researching, evaluating, and resolving claims disputes in line with regulations, policies, and industry standards. The specialist will also conduct root cause analyses, process claims readjustments, support system improvements, and manage the overpayment recoupment process.

The role requires an individual with strong analytic skills and critical thinking/problem solving skills. This individual must also have exceptional interpersonal skills to build and maintain positive working relationships.

Key Responsibilities:

  • Review and resolve provider payment disputes and appeals for Medi-Cal Managed Care, Medicare Advantage, and PACE programs.
  • Respond to complex provider inquiries regarding claims adjudication and payments.
  • Ensure timely and accurate resolutions to disputes per regulatory guidelines.
  • Maintain accurate records of dispute resolutions and update tracking systems.
  • Identify and correct claims payment errors, process adjustments, and handle provider overpayment refunds.
  • Analyze payment trends and escalate training or process improvement needs.
  • Assist with health plan audits and other projects related to provider dispute process as required.
  • Identify system configuration issues and report for resolution.
  • Performs other job duties as required by manager/supervisor and NEMS Management Team.
  • Bachelor’s degree preferred. Associate degree with relevant experience may be considered.
  • Minimum five years of experience in medical claims adjudication required.
  • Strong analytical, problem-solving, and communication (written & verbal) skills.
  • Knowledge of Medi-Cal & Medicare Advantage claims reimbursement and dispute resolution.
  • Familiarity with healthcare compliance (HIPAA, CMS, DHCS, AB1455).
  • Understanding of medical terminology, coding, and claim forms.
  • Detail-oriented with strong organizational and time management skills.
  • Proficiency in PC-based software and database management.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in other languages are an asset.

STATUS:

  • This is an FLSA Non-Exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position.


NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

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