Provider Dispute and Resolution Analyst III

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 77,000 - 124,000; Full time

Benefits offered by this job

PTO

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan is seeking a Provider Dispute and Resolution Analyst III to independently manage complex provider claims and reimbursement disputes, ensuring payments align with contractual obligations.

The role conducts root-cause analyses, coordinates cross-functional resources, and supports settlements with well-documented case summaries and clear provider communication. Mentors staff and drives continuous improvement within the team.

Qualifications

• Bachelor's Degree or equivalent experience.
• At least 3 years managing complex provider claims and reimbursement disputes.
• Experience interpreting contract terms, analyzing claims data, and resolving financial discrepancies.
• Experience coordinating cross-functional teams including Claims, Configuration, Finance, Legal and Compliance.
• Experience supporting non-litigation settlements is preferred.

Responsibilities

• Independently manage the full lifecycle of complex provider claims and reimbursement disputes.
• Conduct root-cause analyses of recurring system issues to drive improvements.
• Validate disputed amounts and prepare documentation for settlement reviews.
• Prepare concise case summaries for escalations and maintain provider communication.
• Identify opportunities for process improvements and technical guidance.

Skills

Root-cause analysis

Data synthesis

Attention to detail

Contractual compliance

Written communication

Verbal communication

Dispute management

Claims processing systems

Documentation tools

Collaboration

Leadership (preferred)

Education

Bachelor's degree

Tools

Claims processing systems

Job description

Salary Range: $77,265.00 (Min.) - $100,445.00 (Mid.) - $123,625.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation's largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

(1 position available) The Provider Dispute and Resolution Analyst III independently manages complex provider claims and reimbursement disputes, ensuring payments align with contractual obligations through advanced analysis of claims, contracts, and provider data. The role conducts root-cause analyses to resolve systemic issues, coordinates cross-functional resources, and supports non-litigation settlements by validating disputed amounts and preparing documentation. As subject matter expert Analyst delivers clear case summaries, maintains professional provider communication, and promotes continuous improvement and technical guidance within the team. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff.

Duties

Acts as an enterprise resource, entrusted with independently managing the full lifecycle of complex provider claims and reimbursement disputes—from initial intake through final resolution and provider communication. Research and synthesize claims, payment histories, contract terms, reimbursement exhibits, system configurations, and provider data, ensuring that all disputed payments are rigorously evaluated against contractual obligations.

Conducts structured root-cause analyses of recurring system reimbursement issues, proactively addressing underlying causes to drive sustainable improvements. Manages multiple concurrent disputes often involving significant claim volumes, financial exposure, and provider sensitivity the Analyst develops actionable findings and resolution recommendations, frequently coordinating cross-functional resources across key stakeholders.

Validates disputed financial amounts at both line-level and aggregate, preparing comprehensive documentation for settlement review and approval, and ensuring seamless downstream processing with Claims and Finance. Prepares concise case summaries for significant provider escalations, articulating issue history, claim volume, contractual basis, financial exposure, root cause, and recommended resolution.

Maintains professional and objective communication with providers, serving as a trusted point of contact. Responsible for continuous improvement, and identifying opportunities, . Elevates the organization’s capacity to resolve provider disputes efficiently, accurately, and with lasting impact.

Apply subject matter expertise in evaluating business operations and processes. Identify areas where technical solutions would improve business performance. Consult across business operations, provide mentorship, and contribute specialized knowledge. Ensure that the facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provide training and recommend process improvements as needed.

Performs other duties as assigned.

Education Required

Bachelor's Degree

In lieu of degree, equivalent education and/or experience may be considered.

Experience

Required

At least 3 years of experience in managing complex provider claims and reimbursement disputes within a healthcare or managed care environment.

Experience interpreting contract terms, analyzing claims data, and resolving financial discrepancies is essential.

Experience coordinating cross-functional teams including Claims, Configuration, Finance, Legal, and Compliance. is critical for addressing multifaceted issues and implementing sustainable solutions.

Preferred

Experience supporting non-litigation settlements, including validating disputed financial amounts and preparing comprehensive documentation for review and approval.

Skills

Required

Advance knowledge of root-cause analysis and systemic process improvement.

Skills include advanced analytical abilities to synthesize large volumes of claims and provider data, strong attention to detail, and the capacity to evaluate disputed payments against contractual obligations.

Excellent written and verbal communication skills to prepare concise case summaries and maintain professional, objective interactions with providers during sensitive financial disputes.

Ability to manage multiple concurrent disputes, prioritize tasks, and deliver actionable recommendations is vital.

Strong technical skills and proficiency with claims processing systems and documentation tools.

Collaboration skills, accountability, and sound decision-making.

Preferred

Ability to demonstrated leadership in continuous improvement initiatives, share best practices, and provided technical guidance to junior staff will be well-positioned for success.

Physical Requirements

Light

Additional Information

Travel to offsite locations for work required.

Salary Range Disclaimer:

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care Offers a Wide Range Of Benefits Including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program
• Volunteer Time Off (VTO)