Dispute Specialist

WelbeHealth

3d • $34 - $39

About The Position

At WelbeHealth, the Dispute Specialist oversees and resolves first-level disputes between WelbeHealth and contracted and non-contracted providers involving claim payments, claim denials, and contractual agreements. The role collaborates with departmental team members and internal partners to identify trends, educate providers on proper processing, support compliance in claims-related processes, and promote provider satisfaction.

The position investigates and resolves disputes, completes acknowledgment and determination letters, documents actions and decisions, and creates correspondence for the Senior Examiner. It also works with leadership on improper-processing trends and claim-related concerns that result in disputes. The specialist maintains knowledge of claim-processing rules and requirements and may assist with data entry of incoming clean claims when needed.

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.
• At least three years of health plan claims-processing experience and two years of health plan claims-dispute experience analyzing and resolving provider claims.
• Strong computer and software knowledge, including Excel, Outlook, PowerPoint, Word, and Teams, and job-specific applications or systems for producing correspondence, charts, spreadsheets, and other relevant information.
• Ability to navigate state and federal websites and medical billing guidelines and use online resources to resolve outstanding claims and disputes.
• Excellent verbal and written communication, organizational, time-management, problem-solving, and decision-making skills.

Responsibilities

• Examine claim records and forms to investigate and resolve first-level disputes while meeting established quality and production standards.
• Complete acknowledgment and determination letters and provide detailed notes on actions taken, including dispute decisions and reasoning.
• Create correspondence for the Senior Examiner and work with leadership on improper-processing trends and claim-related concerns resulting in disputes.
• Establish and maintain effective working relationships with team members, interdepartmental staff, and leadership.
• Maintain comprehensive knowledge of claim-processing guidelines, procedures, governing regulations, and compliance requirements.
• Assist with data entry of incoming clean claims when needed.

Benefits

• Medical, dental, and vision insurance coverage.
• 17 days of personal time off (PTO), 12 annually observed holidays, and sick time.
• 401(k) savings with employer match.
• Advancement opportunities, including a record of hiring and promoting from within.
• Competitive total rewards package, including comprehensive healthcare coverage and additional benefits.
• Compensation includes base salary plus bonus.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED