Provider Dispute Resolution Specialist - Hybrid - 141256

University of California San Diego; San Diego (CA); Hybrid; USD 41,000 - 61,000; Full time

Job summary

UC San Diego Health is seeking a Provider Dispute Resolution Specialist to manage end-to-end claim appeals with a hybrid work schedule (onsite at Greenwich Drive, San Diego, CA, and remote). The role emphasizes accuracy in intake, categorization, acknowledgement, and resolution, with strong attention to documentation and provider notification.

Qualifications include 6 years of related experience or a bachelor’s degree plus 2 years, proficient communication, discretion, and data analysis skills,

Qualifications

• Six years of related experience, education/training, OR a Bachelor’s degree in related area plus two (2) years of related experience/training.
• Working knowledge of common organization- or research-specific and other computer application programs.
• Proficient in communication and interpersonal skills to communicate effectively, both verbally and in writing.
• Proficient in ability to use discretion and maintain all confidentiality.
• Demonstrates ability to use sound judgment in responding to issues and concerns
• Demonstrates ability to analyze, research and synthesize large amounts of data with strong attention to detail.
• Proficient in ability to multi-task with demanding timeframes.
• Working knowledge of applicable policy analysis techniques.

Responsibilities

• End-to-end claims appeal process including claim appeal intake, categorization, acknowledgement, resolution, documentation, provider notification, claim reprocessing, tracking, trending and reporting.

Skills

Communication skills

Discretion

Confidentiality

Data analysis

Multi-tasking

Judgment

Policy analysis techniques

Education

Bachelor’s degree in related area

2 years related experience

Tools

Epic Tapestry

Job description

Payroll Title: PROJECT POLICY ANL 2 RP

Department: PHSO - MSO

Hiring Pay Scale: $30.32 - $44.47 / Hourly

Worksite: Greenwich Drive

Appointment Type: Career

Appointment Percent: 100%

Union: RP Contract

Total Openings: 1

Work Schedule: Days, 8 hrs/day, Monday-Friday

#141256 Provider Dispute Resolution Specialist - Hybrid

Filing Deadline: Wed 9/30/2026

UCSD Layoff from Career Appointment: Apply by 09/21/26 for consideration with preference for rehire. All layoff applicants should contact their Employment Advisor.

Reassignment Applicants: Eligible Reassignment clients should contact their Disability Counselor for assistance.

This position has recently been accreted by UAW RP union and will be a part of that union moving forward.

This position will work a hybrid schedule which includes a combination of working both onsite at Greenwich Drive (San Diego, CA) and remote.

DESCRIPTION

Responsible for end-to-end claims appeal process including, but not limited to, claim appeal intake, categorization, acknowledgement, resolution, documentation, provider notification, claim reprocessing, tracking, trending and reporting.

MINIMUM QUALIFICATIONS

• Six (6) years of related experience, education/training, OR a Bachelor’s degree in related area plus two (2) years of related experience/training. Related experience: processing professional and facility claims within Epic Tapestry.
• Working knowledge of common organization- or research-specific and other computer application programs.
• Proficient in communication and interpersonal skills to communicate effectively, both verbally and in writing.
• Proficient in ability to use discretion and maintain all confidentiality.
• Demonstrates ability to use sound judgment in responding to issues and concerns
• Demonstrates ability to analyze, research and synthesize large amounts of data with strong attention to detail.
• Proficient in ability to multi-task with demanding timeframes.
• Working knowledge of applicable policy analysis techniques.

PREFERRED QUALIFICATIONS

• Experience reviewing, approving and denying claim appeals in Epic Tapestry.
• Experience interpreting Division of Financial Responsibility (DOFR) agreements and delegated claims payment responsibilities.
• Knowledge of California provider dispute resolution requirements and managed care regulatory standards.

SPECIAL CONDITIONS

• Must be able to work various hours and locations based on business needs.
• Employment is subject to a criminal background check and pre-employment physical.

Pay Transparency Act

Annual Full Pay Range: Unclassified - No data available (will be prorated if the appointment percentage is less than 100%)

Hourly Equivalent: Unclassified - No data available

Factors in determining the appropriate compensation for a role include experience, skills, knowledge, abilities, education, licensure and certifications, and other business and organizational needs. The Hiring Pay Scale referenced in the job posting is the budgeted salary or hourly range that the University reasonably expects to pay for this position. The Annual Full Pay Range may be broader than what the University anticipates to pay for this position, based on internal equity, budget, and collective bargaining agreements (when applicable).

If employed by the University of California, you will be required to comply with our Policy on Vaccination Programs, which may be amended or revised from time to time. Federal, state, or local public health directives may impose additional requirements.

If applicable, life-support certifications (BLS, NRP, ACLS, etc.) must include hands‑on practice and in‑person skills assessment; online-only certification is not acceptable.

UC San Diego Health is the only academic health system in the San Diego region, providing leading-edge care in patient care, biomedical research, education, and community service. Our facilities include two university hospitals, a National Cancer Institute-designated Comprehensive Cancer Center, Shiley Eye Institute, Sulpizio Cardiovascular Center, the only Burn Center in the county, and dozens of outpatient clinics. We invite you to join our team!

Applications/Resumes are accepted for current job openings only. For full consideration on any job, applications must be received prior to the initial closing date. If a job has an extended deadline, applications/resumes will be considered during the extension period; however, a job may be filled before the extended date is reached.

To foster the best possible working and learning environment, UC San Diego strives to cultivate a rich and diverse environment, inclusive and supportive of all students, faculty, staff and visitors. For more information, please visit UC San Diego Principles of Community.

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.

For the University of California’s Anti-Discrimination Policy, please visit: https://policy.ucop.edu/doc/1001004/Anti-Discrimination

UC San Diego is a smoke and tobacco free environment. Please visit smokefree.ucsd.edu for more information.

UC San Diego Health maintains a marijuana and drug free environment. Employees may be subject to drug screening.

Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts an offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; or have filed an appeal of a finding of substantiated misconduct with a previous employer.

a. "Misconduct" means any violation of the policies governing employee conduct at the applicant’s previous place of employment, including, but not limited to, violations of policies prohibiting sexual harassment, sexual assault, or other forms of harassment, or discrimination, as defined by the employer. For reference, below are UC’s policies addressing some forms of misconduct:

• UC Sexual Violence and Sexual Harassment Policy
• UC Anti-Discrimination Policy
• Abusive Conduct in the Workplace