Provider Disputes & Resolutions Specialist

Blue Cross and Blue Shield of Louisiana Inc.; Baton Rouge (LA); On-site; USD 55,000 - 75,000; Full time

Job summary

Blue Cross and Blue Shield of Louisiana seeks a Provider Disputes Coordinator to ensure accurate classification and processing of disputes for HMOLA and BCBSLA. Residency in Louisiana is preferred; reporting to the Monroe or Baton Rouge office.

You will coordinate responses, review calls and documentation, and ensure compliance with accreditation guidelines and state laws. Strong attention to detail and excellent communication are essential.

Qualifications

• High school diploma or equivalent required.
• 4 years health insurance experience required; 2 years in customer service or provider relations preferred.
• Ability to read and interpret benefits across lines of business.
• Thorough knowledge of claims process and adjustment procedures.
• Knowledge of accreditation guidelines, state laws, and internal claims systems.
• Working knowledge of PC software; Facets experience required.
• Strong attention to detail, record-keeping, and communication skills.
• Able to work in a fast-paced, changing environment; presentations/public speaking skills required.

Responsibilities

• Coordinate response activities between appropriate departments, reviewing calls and related documentation to verify pricing and analyze errors.
• Send written resolution letters within required timeframes for provider disputes.
• Provide acknowledgement letters to notify receipt and timelines for dispute resolution.
• Coordinate and host Management Level Provider Dispute meetings with internal and external parties, prepare packets, and take minutes.
• Facilitate meetings to ensure all viewpoints are heard and addressed.
• Coordinate audits and adjustments for systemic issues and provide on-site or telephonic education on contract concerns.
• Back up for Appeals and Grievance Analysts and other team duties as needed.
• Close inventory with accuracy to address all concerns.

Skills

Benefits interpretation

Claims processing

Accreditation guidelines

State laws

Claims systems

Facets experience

Attention to detail

Record keeping

Communication skills

Public speaking

Education

High School Diploma or equivalent

Tools

Facets

Job description

Blue Cross and Blue Shield of Louisiana seeks a Provider Disputes Coordinator to ensure accurate classification and processing of disputes for HMOLA and BCBSLA. Residency in Louisiana is preferred; reporting to the Monroe or Baton Rouge office.

You will coordinate responses, review calls and documentation, and ensure compliance with accreditation guidelines and state laws. Strong attention to detail and excellent communication are essential.