Texas Licensed Provider Dispute Adjuster

Job Summary

A company is looking for a Provider Dispute & NSA Adjuster (remote).

Key Responsibilities

• Manage provider disputes from intake through final resolution in accordance with regulatory timeframes
• Serve as the primary point of contact for open negotiation and Independent Dispute Resolution (IDR) cases
• Analyze dispute trends and collaborate with teams to improve processes and workflows

Required Qualifications

• 3-5 years of experience in a commercial health plan environment, focusing on claims and provider disputes
• Strong knowledge of Texas open negotiation and federal IDR processes
• Understanding of Texas vs. federal dispute frameworks
• Proficiency in claims processing systems and basic data analysis tools
• Experience drafting professional provider responses