Provider Dispute Resolution Analyst II

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 67,000 - 107,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan is hiring two Provider Dispute and Resolution Analysts II to investigate, analyze, and resolve provider claims and payment disputes for contracted network providers in a timely and accurate manner.

These roles require strong analytical abilities, meticulous documentation, and collaboration with Claims, Configuration, and Finance teams to ensure fair outcomes and alignment with contractual payment terms.

Qualifications

• At least 2 years of experience researching, analyzing, coordinating, and resolving provider claims and payment disputes in a healthcare or managed care setting.
• Experience reviewing provider claims, payment information, and supporting documentation to determine the appropriate resolution pathway.
• Ability to work within policies and escalation protocols and collaborate with Claims, Configuration, Finance, and provider contract representatives.

Responsibilities

• Research and resolve routine to moderately complex provider claims and reimbursement disputes.
• Coordinate with stakeholders to validate disputes against contractual rates and payment mechanisms.
• Maintain accurate case records and communicate findings and resolution status to providers.
• Escalate high-risk or ambiguous matters to leadership for strategic oversight.
• Support provider settlement activities including documentation and tracking of progress.

Skills

Analytical skills

Record-keeping

Cross-functional collaboration

Communication skills

Education

Associate's Degree

Job description

L.A. Care Health Plan is hiring two Provider Dispute and Resolution Analysts II to investigate, analyze, and resolve provider claims and payment disputes for contracted network providers in a timely and accurate manner.

These roles require strong analytical abilities, meticulous documentation, and collaboration with Claims, Configuration, and Finance teams to ensure fair outcomes and alignment with contractual payment terms.