Dispute Specialist

📋 Description

• Examine claim records and forms to investigate and resolve first level disputes, meeting and
• Process the completion of acknowledgment and determination letters, as well as provide detailed
• Create correspondence for the Senior Examiner and work closely with leadership on improper
• Establish and maintain effective working relationships with team members and interdepartmental
• Maintain comprehensive knowledge of claim processing guidelines, procedures, governing regulations
• Assist with the data entry of incoming clean claims in times of need

🎯 Requirements

• High school diploma or equivalency, professional experience may be substituted
• Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment
• Minimum of three (3) years of health plan claims processing experience, and two (2) years of health
• Strong computer and software knowledge (e.g., Excel, Outlook, PowerPoint, Word, Teams), as well as
• Ability to navigate the complexities of state/federal websites and medical billing guidelines
• Excellent verbal and written communication skills, organizational and time management skills, and

🎁 Benefits

• Medical insurance coverage (Medical, Dental, Vision)
• Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually
• 401K savings + match
• Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning
• And additional benefits