Dispute Specialist

At WelbeHealth, we serve our communities’ most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what.

The Dispute Specialist plays a crucial role in overseeing and resolving first-level disputes between WelbeHealth and its contracted and non-contracted providers regarding claim payments, claim denials, and contractual agreements. This role works closely with departmental team members and internal partners to identify trends and educate providers on proper processing, to ensure we are compliant in all claims related processes and to promote provider satisfaction.

Essential Job Duties:

• Examine claim records and forms to investigate and resolve first level disputes, meeting and maintaining established quality and production standards
• Process the completion of acknowledgment and determination letters, as well as provide detailed notes on actions taken, such as dispute decision and reasoning
• Create correspondence for the Senor Examiner and work closely with leadership on improper processing trends and claim related concerns resulting in disputes
• Establish and maintain effective working relationships with team members and interdepartmental staff and leadership
• Maintain comprehensive knowledge of claim processing guidelines, procedures, governing regulations, and compliance requirements
• Assist with the data entry of incoming clean claims in times of need

Qualifications and Requirements:

• High school diploma or equivalency, professional experience may be substituted
• Experience in a Managed Care Plan (MCP) or PACE organization (PO) claims processing environment
• Minimum of three (3) years of health plan claims processing experience, and two (2) years of health plan claims dispute experience analyzing and resolving provider claims
• Strong computer and software knowledge (e.g., Excel, Outlook, PowerPoint, Word, Teams), as well as job-specific applications/systems to produce correspondence, charts, spreadsheets, and other relevant information
• Ability to navigate the complexities of state/federal websites and medical billing guidelines, using online resources to resolve outstanding claims and disputes
• Excellent verbal and written communication skills, organizational and time management skills, and problem solving and decision-making skills

Our Commitment to Diversity, Equity and Inclusion

At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. People seeking employment at WelbeHealth are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information or characteristics (or those of a

family member), pregnancy or other status protected by applicable law.

Beware of Scams

Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment. You can report suspected scam activity to fraud.report@welbehealth.com