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
Benefits of Working at WelbeHealth: Apply your expertise in new ways as we rapidly expand. You will have the opportunity to design the way we work in the context of an encouraging and loving environment where every person feels uniquely cared for.
- Medical insurance coverage (Medical, Dental, Vision)
- Work/life balance - we mean it! 17 days of personal time off (PTO), 12 holidays observed annually, and sick time
- 401K savings + match
- Advancement opportunities - we’ve got a track record of hiring and promoting from within, meaning you can create your own path!
- And additional benefits
Compensation consists of base salary plus bonus. WelbeHealth offers a competitive total rewards package that includes a 401(k) match, comprehensive healthcare coverage, and a broad range of additional benefits. Actual compensation will be determined based on experience and relevant qualifications.
COVID-19 Vaccination Policy
At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and has requirements relevant to all team members regarding vaccinations.
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 [email protected]
Skills Required
- High school diploma or equivalent; professional experience may substitute
- Experience in a Managed Care Plan or PACE organization claims processing environment
- At least three years of health plan claims processing experience
- At least two years of health plan claims dispute experience analyzing and resolving provider claims
- Strong computer and software knowledge, including Excel, Outlook, PowerPoint, Word, Teams, and job-specific systems
- Ability to navigate state and federal websites and medical billing guidelines to resolve claims and disputes
- Excellent verbal and written communication, organizational, time management, problem-solving, and decision-making skills
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What We Do
WelbeHealth provides full-service care to help seniors age well at home and in their community, often at no cost. Services include medical, coordination, home care, dental, transport, physical therapy, prescriptions, social activities and meals. Founded by a seasoned group of physician entrepreneurs, our leadership team hails from leading payer and provider organizations such as GoHealth Urgent Care, BAYADA Home Health, AirStrip Technologies, Evolent Health, and On Lok. With funding from leading venture investors, we're looking for team members who are inspired to help us deliver on our mission of unlocking the full potential of the most vulnerable seniors. Our colleagues are energized by working in diverse groups toward our shared purpose, are eager to drive groundbreaking innovations, and have the courage to care for our participants with empathy and love.
