Independent Dispute Resolution Specialist

MedPro Group • Springfield, MA

1d • $26 - $31 • Hybrid

About The Position

Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life – from grade school to college to the workplace.
Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation’s leading providers of health and accident insurance products to the higher education market.
Wellfleet, a Berkshire Hathaway Company, seeks an experienced Independent Dispute Resolution (IDR) Specialist to support the Wellfleet Student Health team.
The Independent Dispute Resolution Specialist (IDR) is responsible for overseeing the Federal Independent Dispute Resolution (No Surprise Act) claim dispute process to ensure quality and timely handling of disputes. Must possess good communication skills, be detail oriented problem solver with good analytical and time management skills.
In this role, you will…

Requirements

• High school diploma with 3+ years’ work experience in the insurance field, preferably working in a health insurance setting or Professional Certification in Billing and Coding
• Experience in medical billing or claims handling
• Understanding of medical billing and codes
• Demonstrated ability to efficiently manage multiple assignments, prioritize tasks and adapt to changes in a fast-paced environment to meet deadlines
• Possess effective communication skills and be patient, resilient and stress tolerant
• Responsible and dependable with focus on attention to detail
• Excellent phone etiquette skills
• Strong proficiency with Microsoft suite products including advanced MS Excel

Nice To Haves

• Experience with the Federal IDR process is preferred

Responsibilities

• Be able to navigate the company claim system and process adjustments
• Be able to interpret policy language
• Maintain a working knowledge of State/Federal insurance regulations and mandates
• Maintain understanding of the products serviced by Wellfleet
• Maintain knowledge of company systems
• Respond to email inquiries from vendors and IDR entities professionally, accurately, and promptly
• Maintain comprehension in interpreting documents, such as training manuals, correspondence, brochures, policies etc.
• Manage Independent Dispute Resolution (IDR) inquiries by ensuring applicability and timely and accurate payment of IDR entity fees
• Maintain IDR files to support determinations, ensuring eligibility based on federal regulations, and meeting strict deadlines
• Process IDR determination adjustments in accordance with plan benefits
• Work with vendors associated with IDR process as well as Wellfleet legal team to identify areas of process improvement
• Prepare supporting documentation to appeal non-eligible IDR disputes
• Assist with printing and correlating vendor appeals ensuring timely entry into claims system
• Assist with processing vendor fees
• Ability to multitask and adhere to deadlines and handle special projects
• Follow company and department workflows as approved by management
• Communicate issues, concerns etc. to supervisor in a timely manner
• Perform other duties as assigned

Benefits

• Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress.

What This Job Offers

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