Provider Dispute & Resolution Analyst II — Impact & Growth

L.A. Care; 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

Job summary

L.A. Care Health Plan in Los Angeles, CA invites applications for a Provider Dispute and Resolution Analyst II. The role researches, analyzes, coordinates, and resolves provider claims, payment disputes, and reimbursement issues for contracted network providers.

The Analyst II works within established policies and escalation protocols to ensure accurate resolutions, while supporting non-litigation settlement activities and maintaining precise case records with clear communication to providers.

Qualifications

• Associate's Degree required; equivalent education and/or experience may be considered.
• At least 2 years of experience researching, analyzing, coordinating, and resolving provider claims, payment disputes, and reimbursement issues in a healthcare or managed care environment.
• Experience reviewing provider claims, payment information, contract terms, and supporting documentation to determine the appropriate resolution pathway.
• Experience working within policies, workflows, reimbursement guidance, and escalation protocols; collaborate with Claims, Configuration, Finance, and provider contract representatives to resolve provider concerns.
• Preferred: experience preparing documentation for settlement evaluation.

Responsibilities

• Safeguards the organization’s financial and reputational interests by managing provider claims and reimbursement disputes.
• Reviews and resolves routine to moderately complex cases, requiring thorough research of claim histories and provider documentation to ensure fair and accurate outcomes.
• Partners with key stakeholders to validates disputes against contractual rates and payment mechanisms, documenting remediation activities with precision.
• Maintains meticulous case records and fostering timely, transparent communication with providers.
• Escalates disputes that surpass established complexity or financial thresholds, ensuring senior leadership engagement when strategic oversight is required.
• Delivers analytical support for provider settlement reviews by researching claims and payment histories, reconciling disputed inventories, preparing documentation for settlement evaluation, and tracking approved activities.
• Establishes dispute resolution policies and frameworks, preparing clear, provider-facing responses that communicate findings and resolution status.
• Champions continuous improvement, shares best practices, and promotes a culture of accountability, collaboration, and decision quality.

Skills

Analytical abilities

Record keeping

Cross-functional collaboration

Provider communications

Escalation to leadership

Attention to detail

Education

Associate's Degree

Job description

L.A. Care Health Plan in Los Angeles, CA invites applications for a Provider Dispute and Resolution Analyst II. The role researches, analyzes, coordinates, and resolves provider claims, payment disputes, and reimbursement issues for contracted network providers.

The Analyst II works within established policies and escalation protocols to ensure accurate resolutions, while supporting non-litigation settlement activities and maintaining precise case records with clear communication to providers.