Dispute Resolution Specialist II

About the role

The organization operates in the healthcare sector, focusing on controlling and reducing healthcare costs. It addresses challenges related to managing healthcare expenses by leveraging technology, data, and innovation. The team is committed to service excellence for both internal and external stakeholders and aims to become a recognized voice in healthcare technology and data innovation.

The Dispute Resolution Specialist II manages arbitration cases involving provider disputes and client payment offers. The role is responsible for analyzing and resolving complex escalated issues related to Independent Dispute Resolution (IDR) processes governed by federal and state laws. This position ensures efficient case management, coordination across teams, and compliance with regulatory requirements, directly impacting the organization’s ability to resolve disputes effectively.

Responsibilities

• Determine appropriate client plan arbitration offers
• Draft briefs and offers supporting client positions per federal regulations
• Conduct due diligence through research for arbitration package preparation
• Collaborate with other departments to gather necessary information for IDR submissions
• Review and analyze clinical and provider-submitted documents of moderate to high complexity
• Meet federal filing deadlines and turnaround times
• Respond promptly to all communications and maintain detailed records
• Contact clients to obtain data for arbitration packages
• Maintain department productivity and quality standards
• Ensure compliance with HIPAA privacy regulations
• Collaborate across disciplines and departments
• Uphold core company competencies and values
• Perform other duties as assigned

Requirements

• Minimum high school diploma or equivalent (GED) with four years of healthcare operations experience; bachelor’s degree preferred
• Strong organizational, analytical, and independent decision-making skills
• Proven problem-solving ability managing multiple priorities and deadlines
• Proactive approach to anticipating needs and solving problems in a fast-paced environment
• Sound business judgment
• Ability to learn quickly and work independently within time constraints
• Proficiency in Microsoft Word, Excel, and Outlook
• Clear and concise written and verbal communication skills
• Ability to work in a standard office environment requiring extended computer use and standard office equipment operation

Pay

Pay range is $19-21 per hour, determined by education, experience, skills, work location, and internal equity. Eligible for health insurance, 401(k) plan, and bonus opportunity.

Benefits

• Medical, dental, and vision coverage with low deductibles and copays
• Life insurance
• Short and long-term disability
• Paid parental leave
• 401(k) with company match
• Employee Stock Purchase Plan
• Generous paid time off accrued based on years of service
• Ten paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Sick time benefits as per state laws