Dispute Resolution Specialist II

Role Overview

This role manages an arbitration case load, including evaluation of provider disputes and client payment offers. The incumbent will coordinate efforts with the team and leadership to bring matters to efficient and successful outcomes. The incumbent’s primary responsibility will be to oversee and manage the intake, processing and coordination of all materials and information relating to the Independent Dispute Resolution (IDR) as regulated by Federal or State law.

What You Will Do

Assume primary responsibility for determining appropriate client plan arbitration offers, draft briefs and offers, conduct due diligence, work with other departments, review and analyze clinical information, meet federal filing deadlines, respond to communications, and maintain detailed and accurate records.

Why It Might Be a Fit

This position requires excellent organizational, analytical and independent decision-making skills, demonstrated problem solving skills, ability to manage multiple priorities, sound business judgement, and ability to learn quickly and work independently.

Requirements

• Minimum high school diploma or equivalent (GED) and four (4) years’ experience in healthcare operations
• Bachelors’ degree in a related field is preferred
• Excellent organizational, analytical and independent decision-making skills
• Demonstrated problem solving skills with the ability to manage multiple priorities and meet associated timelines
• Ability to anticipate needs and solve problems proactively in a fast paced, rapidly changing environment
• Sound business judgement
• Ability to learn quickly and work independently within time constraints
• Adept knowledge of Microsoft Word, Excel and Outlook
• Logical, clear and concise written and verbal communication skills

Benefits

• Medical, dental and vision coverage with low deductible & copay
• Life insurance
• Short and long-term disability
• Paid Parental Leave
• 401(k) + match
• Employee Stock Purchase Plan
• Generous Paid Time Off – accrued based on years of service
• 10 paid company holidays
• Tuition reimbursement
• Flexible Spending Account
• Employee Assistance Program
• Sick time benefits – for eligible employees, one hour of sick time for every 30 hours worked, up to a maximum accrual of 40 hours per calendar year

Originally posted on Himalayas