Provider Dispute Strategist

bcbsla; Baton Rouge (LA); On-site; USD 55,000 - 75,000; Full time

Job summary

BCBSLA is seeking a Provider Disputes Analyst to ensure accurate classification and timely processing of provider disputes for HMOLA and BCBSLA, coordinating responses and maintaining compliance with accreditation guidelines.

The role reports to SUPERVISOR, PROVIDER DISPUTES and requires reading benefits, understanding claims, and communicating clearly with internal teams, physicians, and members in a fast-paced environment.

Qualifications

• High School Diploma or equivalent required.
• 4 years of health insurance experience required.
• 2 years in a customer service or provider relations environment preferred.
• Must read and interpret benefits across lines of business.
• Thorough knowledge of claims process and adjustment procedures.
• Detailed knowledge of accreditation guidelines, state laws, and internal claims systems.
• Proficient PC software and systems; Facets experience required.
• Strong attention to detail and record-keeping.
• Ability to work in a fast-paced, changing environment.
• Excellent grammar, verbal and written communication; presentation skills.

Responsibilities

• Coordinate response activities between departments; verify pricing and analyze claim data for errors.
• Send written resolution letters within required timeframes.
• Facilitate management-level provider dispute meetings and take minutes.
• Provide audits and adjustments for systemic problems; onsite or telephonic education.
• Backups for Appeals and Grievance Analysts; manage inventory accurately.
• Close inventory with accuracy; address concerns thoroughly.
• Perform other related duties and comply with laws.

Skills

Benefits interpretation

Claims process knowledge

Accreditation guidelines knowledge

PC software

Facets experience

Attention to detail

Communication skills

Public speaking

Education

High School Diploma

Tools

Facets

Job description

BCBSLA is seeking a Provider Disputes Analyst to ensure accurate classification and timely processing of provider disputes for HMOLA and BCBSLA, coordinating responses and maintaining compliance with accreditation guidelines.

The role reports to SUPERVISOR, PROVIDER DISPUTES and requires reading benefits, understanding claims, and communicating clearly with internal teams, physicians, and members in a fast-paced environment.