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Provider Dispute Resolution Specialist Jobs (NOW HIRING)

Senior Provider Claims Dispute Specialist

IL · Remote

$34.60 - $39.40/hr

The Senior Provider Claims Dispute Specialist is responsible for the timely, accurate, and ... This role serves as a subject matter expert for provider dispute resolution policies, CMS ...

IL · On-site

$34.60 - $39.40/hr

The Senior Provider Claims Dispute Specialist is responsible for the timely, accurate, and ... This role serves as a subject matter expert for provider dispute resolution policies, CMS ...

Background in medical billing, claims processing, or payer-provider dispute resolution. Core Competencies * Exceptional attention to detail and organizational discipline. * Ability to manage ...

... Dispute Resolution for our Construction Consulting Practice in Oakland, CA . In this role, you will ... Providing strategic planning to identify, develop, and secure new business opportunities and ...

... Dispute Resolution for our Construction Consulting Practice in Oakland, CA . In this role, you will ... Providing strategic planning to identify, develop, and secure new business opportunities and ...

... Dispute Resolution for our Construction Consulting Practice in Oakland, CA . In this role, you will ... Providing strategic planning to identify, develop, and secure new business opportunities and ...

Showing results 21-40

Provider Dispute Resolution Specialist information

See salary details

$34K

$70.3K

$114.5K

How much do provider dispute resolution specialist jobs pay per year?

As of Sep 11, 2026, the average yearly pay for provider dispute resolution specialist in the United States is $70,345.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $86,500.00 per year, depending on experience, location, and employer.

What does a provider dispute resolution specialist do?

A Provider Dispute Resolution Specialist is responsible for handling and resolving disputes between healthcare providers and health insurance companies. Their primary duties include reviewing claims denials or payment issues, investigating the underlying causes, and facilitating communication between providers and payers to reach a fair resolution. They ensure that all disputes are processed in compliance with regulatory requirements and organizational policies. This role is crucial in maintaining positive relationships between providers and insurers while ensuring timely and accurate payment of healthcare services.

What are the key skills and qualifications needed to thrive as a provider dispute resolution specialist?

To thrive as a Provider Dispute Resolution Specialist, you need a solid understanding of healthcare claims processing, regulations, and dispute resolution practices, often supported by a degree in healthcare administration or a related field. Familiarity with claims management systems, medical coding software, and regulatory tools like HIPAA compliance platforms is typically required. Strong analytical thinking, attention to detail, and effective communication skills help facilitate negotiations and resolve conflicts efficiently. These skills are crucial for ensuring accurate, timely dispute resolution while maintaining compliance and positive provider relationships.

What are some typical challenges a provider dispute resolution specialist faces when resolving claims disputes, and how can they be effectively managed?

Provider Dispute Resolution Specialists often encounter challenges such as interpreting complex insurance policies, managing high volumes of cases, and navigating differing expectations between providers and payers. Effective management involves maintaining strong communication skills, staying up-to-date with regulatory changes, and developing expertise in claims adjudication processes. Building collaborative relationships with internal teams and external stakeholders also helps ensure disputes are resolved efficiently and fairly.

What is the difference between Provider Dispute Resolution Specialist vs Claims Analyst?

AspectProvider Dispute Resolution SpecialistClaims Analyst
CredentialsRelevant certifications in healthcare or dispute resolution, often with industry-specific trainingTypically requires a degree in healthcare administration, finance, or related fields
Work EnvironmentHealthcare organizations, insurance companies, or third-party dispute resolution firmsInsurance companies, healthcare providers, or administrative offices
Employer & Industry UsageUsed in healthcare and insurance sectors to resolve provider disputesCommonly employed in insurance and healthcare to process and analyze claims

The Provider Dispute Resolution Specialist focuses on resolving disputes between healthcare providers and payers, often involving negotiation and specialized knowledge. Claims Analysts primarily review, process, and analyze insurance claims to ensure accuracy and compliance. While both roles work within the healthcare and insurance industries, the Specialist emphasizes dispute resolution, whereas the Analyst concentrates on claims processing and data analysis.

What cities are hiring for Provider Dispute Resolution Specialist jobs?

Cities with the most Provider Dispute Resolution Specialist job openings:

What states have the most Provider Dispute Resolution Specialist jobs?

States with the most job openings for Provider Dispute Resolution Specialist jobs include:

What are popular job titles related to Provider Dispute Resolution Specialist jobs?

For Provider Dispute Resolution Specialist jobs, the most frequently searched job titles are:

MEMBER DISPUTE RESOLUTION SPECIALIST

Reno, NV • On-site

Full-time

Medical, Dental, Vision, Life, PTO

Re-posted 26 days ago


Job description

At Greater Nevada, our passion is helping more people Live Greater, including our members, communities, and each other.

With pride, we strive to make a difference in the lives of our members and the communities they live in through financial inclusion, education, and empowerment. Why? Simply because we believe that together, we Live Greater.

To do this, we practice C.A.R.E. with our Values:

  • WeCare Genuinely.
  • We build relationships because we know that we areGreater Together.
  • WeStay Trustworthyas we serve our communities.
  • "Be Bright"rings in our ears as we find custom solutions that meet our members' needs.
  • WeInspire One Another, our members, and our communities to re-imagine whatLiving Greater can be.
  • In every moment, weEnjoy the Experience. It's what has made the last 70 years greater and what we carry into the future as we continue to serve.

These values have guided us to become the largest Nevada-based credit union to touch the lives of more than88,500 members and thousands upon thousands of people through our community and philanthropic work.

If you're enthusiastic, collaborative, and ready to make an impact, we'd love to meet you!


About The Position:

The Member Dispute Resolution Specialist is responsible for guiding members through the process of filing transactional disputes and other fraud related inquiries. File appropriate bond claims for reimbursement and review of industry alerts for potential breach activity. This role is also responsible for staying informed of possible fraud trends and collaborating with Marketing and Member Services to communicate with members and staff as needed.

What You'll Be Doing

  • Process, investigate, and monitor member disputes from initiation through resolution, ensuring compliance with company policies, regulatory requirements, and service-level agreements while providing timely updates and maintaining accurate documentation.
  • Proactively assess fraud trends in the industry and develop appropriate communications for the membership and staff.
  • Assist members reporting fraud, non-fraud, or potentially fraudulent activity through secure messaging, email, and phone communications, providing high-quality service, recommending appropriate next steps, and guiding them through required documentation and resolution processes.
  • Conduct comprehensive fraud monitoring by reviewing CAM alerts, reporting account breaches and unusual card activity, analyzing transaction patterns, verifying suspicious activity, implementing appropriate account security measures, and documenting findings to prevent financial losses.
  • Follow up with external agencies and internal staff (i.e., law enforcement, shared branching, Marketing) as needed for collaboration.
  • Track and report on statistics of members assisted and fraud trends.
  • Identify abnormal data patterns and provide timely insights to support fraud mitigation or chargeback recovery initiatives.
  • Review and process Verafin alerts related to various types of fraud activity, including investigating cases and preparing Suspicious Activity Reports (SARs) when appropriate.
  • Escalate fraud-related incidents to law enforcement agencies as necessary, including the preparation and filing of police reports and supporting documentation.

Qualifications

  • High school diploma or equivalent required; associate's or bachelor's degree preferred.
  • Minimum of 1-3 years of experience in banking, credit union operations, fraud prevention, dispute resolution, risk management, or a related financial services role.
  • Strong verbal and written communication skills, with the ability to effectively assist members through phone, email, and secure messaging channels required.
  • Strong analytical and reporting skills, including trend identification and data interpretation.
  • Fraud or Card Disputes and Financial Institution Experience preferred
  • Proficient in Microsoft Office Suite, especially Excel and Outlook.
  • Ability to work in a fast-paced, deadline-driven environment.
  • Demonstrated ability to handle sensitive member financial information with confidentiality and professionalism.

Skills & Competencies

  • Excellent communication skills
  • Optimizes work processes
  • Strategic mindset
  • Manages conflict
  • Cultivates innovation
  • Action-oriented

Physical Demands

  • While performing the duties of your job, you may regularly be required to sit and use a keyboard, multiple monitors, mouse, and telephone (including repetitive motions with hands, fingers, arms, etc.) for extended periods of time. You may also frequently be required to stand, walk, and reach with hands and arms, bend, and kneel.
  • You may occasionally be required to lift and/or move up to 20 pounds.

Location and Travel Requirements

The Member Dispute Resolution Specialist position can be located at Greater Nevada Credit Union's Eagle Station or Reno Operations Center location

United States

  • Located in an idyllic small community in beautiful Northern Nevada


Compensation & Benefits

  • $20.19- $28.13per hour
  • Compensation is dependent on experience
  • Medical, dental, and vision plans, where we cover 90% of employee costs and about 75% of the costs for their dependents
  • Health Savings Account contributions
  • Supplemental insurance and life insurance plans
  • Paid time off, including vacation and sick time, 12 annual paid holidays, 2 floating holidays, 1 floating wellness day and sabbatical leave after every seven years of employment
  • Paid time to volunteer and make a contribution to the community
  • Employee product and service discounts

Greater Nevada is an Equal Opportunity Employer

Employment at Greater Nevada is based solely on a person's merit and qualifications directly related to professional competence. Greater Nevada prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.