Out of Network Dispute Analyst

Job Summary

Reviewing and resolving regulated out-of-network disputes, the full-time Out of Network Dispute Resolution Analyst will work remotely to investigate claims, perform rate verifications, and collaborate with internal and external partners to ensure compliance with regulatory requirements.

Key responsibilities

• Review, research, and resolve out-of-network regulatory disputes using sound judgment and appropriate escalation
• Perform rate verification and case analysis in accordance with state and federal regulatory requirements
• Identify root causes, trends, and potential process defects impacting dispute volume and quality

Required qualifications

• High School Diploma / GED or equivalent work experience
• 1+ years of working knowledge of UNET and NDB
• 1+ years of experience in claims processing, including adjustments and management of ORS items
• Managed care or medical insurance experience
• Experience analyzing claim processing through the full adjudication process