Senior Provider Dispute & Resolution Analyst

L.A. Care; Los Angeles (CA); On-site; USD 77,000 - 124,000; Full time

Benefits offered by this job

Paid Time Off

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA is seeking a Provider Dispute and Resolution Analyst III to independently manage complex provider claims and disputes, ensuring payments align with contracts.

You will perform root-cause analyses, coordinate cross-functional resources, and document outcomes for settlements and process improvements. The role requires a Bachelor’s degree and at least 3 years of experience in healthcare claims and dispute resolution, with strong analytical and communication

Qualifications

• At least 3 years' experience managing complex provider claims and reimbursement disputes.
• Experience interpreting contract terms and analyzing claims data to resolve discrepancies.
• Experience coordinating cross-functional teams (Claims, Configuration, Finance, Legal, Compliance).
• Preferred: supporting non-litigation settlements with validated amounts and comprehensive documentation.

Responsibilities

• Act as an enterprise resource managing the full lifecycle of complex provider claims and disputes from intake to final resolution.
• Conduct structured root-cause analyses to drive improvements and coordinate cross-functional resources.
• Prepare concise case summaries for significant provider escalations and ensure proper provider communication.
• Identify opportunities for continuous improvement and mentor staff on best practices.
• Ensure accuracy of facts so deliverables meet policies, standards and legal requirements.

Skills

Root-cause analysis

Claims data analysis

Provider disputes

Cross-functional coordination

Documentation & case summaries

Communication skills

Leadership in improvement

Education

Bachelor's Degree

Tools

Claims processing systems

Documentation tools

Job description

L.A. Care Health Plan in Los Angeles, CA is seeking a Provider Dispute and Resolution Analyst III to independently manage complex provider claims and disputes, ensuring payments align with contracts.

You will perform root-cause analyses, coordinate cross-functional resources, and document outcomes for settlements and process improvements. The role requires a Bachelor’s degree and at least 3 years of experience in healthcare claims and dispute resolution, with strong analytical and communication