Dispute Specialist

About Our Client:The organization operates in the healthcare sector, focusing on serving vulnerable senior populations. It addresses challenges related to healthcare access and service delivery for seniors by fostering a participant-focused approach supported by core values centered on intention, innovation, and care. About the Opportunity:The DISPUTE SPECIALIST is responsible for managing and resolving first-level disputes related to claim payments, denials, and contractual agreements between the organization and its providers. This role contributes to ensuring compliance in claims processing, supporting provider satisfaction, and improving operational effectiveness through collaboration with internal teams. Responsibilities:Investigate and resolve first-level claim disputes, maintaining quality and production standardsPrepare acknowledgment and determination letters and document dispute decisionsGenerate correspondence for senior examiners and collaborate with leadership on claim processing trendsBuild and maintain effective working relationships across departmentsKeep current with claim processing guidelines, regulations, and compliance requirementsAssist with data entry of incoming clean claims as needed Requirements:High school diploma or equivalent; professional experience may substituteExperience in Managed Care Plan or PACE organization claims processingAt least three years of health plan claims processing and two years of claims dispute experienceProficiency with computer software including Excel, Outlook, PowerPoint, Word, and TeamsAbility to navigate state/federal websites and medical billing guidelines for claims resolutionStrong communication, organizational, time management, problem-solving, and decision-making skills Pay Range and Compensation Package:Compensation ranges from $70,304 to $81,395.73 USDBase salary plus bonusActual compensation depends on experience and qualifications Benefits & Perks:Medical, dental, and vision insurance coveragePaid time off including 17 personal days, 12 holidays, and sick time401(k) savings plan with employer matchOpportunities for internal advancement Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin. Note:RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.