Senior Provider Dispute & Resolution Analyst

L.A. Care Health Plan; Los Angeles (CA); Sur place; USD 77 000 - 124 000; Plein temps

Avantages offerts par ce poste

PTO

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Résumé du poste

L.A. Care Health Plan is seeking a Provider Dispute and Resolution Analyst III to independently manage complex provider claims and reimbursement disputes, ensuring payments align with contractual obligations.

The role conducts root-cause analyses, coordinates cross-functional resources, and supports settlements with well-documented case summaries and clear provider communication. Mentors staff and drives continuous improvement within the team.

Qualifications

• Bachelor's Degree or equivalent experience.
• At least 3 years managing complex provider claims and reimbursement disputes.
• Experience interpreting contract terms, analyzing claims data, and resolving financial discrepancies.
• Experience coordinating cross-functional teams including Claims, Configuration, Finance, Legal and Compliance.
• Experience supporting non-litigation settlements is preferred.

Responsabilités

• Independently manage the full lifecycle of complex provider claims and reimbursement disputes.
• Conduct root-cause analyses of recurring system issues to drive improvements.
• Validate disputed amounts and prepare documentation for settlement reviews.
• Prepare concise case summaries for escalations and maintain provider communication.
• Identify opportunities for process improvements and technical guidance.

Connaissances

Root-cause analysis

Data synthesis

Attention to detail

Contractual compliance

Written communication

Verbal communication

Dispute management

Claims processing systems

Documentation tools

Collaboration

Leadership (preferred)

Formation

Bachelor's degree

Outils

Claims processing systems

Description du poste

L.A. Care Health Plan is seeking a Provider Dispute and Resolution Analyst III to independently manage complex provider claims and reimbursement disputes, ensuring payments align with contractual obligations.

The role conducts root-cause analyses, coordinates cross-functional resources, and supports settlements with well-documented case summaries and clear provider communication. Mentors staff and drives continuous improvement within the team.