Provider Disputes Support Specialist

Provider Disputes Support SpecialistPut Your Healthcare Claims Experience to Work

Are you a healthcare or insurance professional who is highly organized, detail-oriented, and great at keeping multiple priorities moving? Do you have experience with medical claims, provider services, member services, or healthcare operations?

We're looking for a Provider Disputes Support Specialist to join a collaborative healthcare operations team. In this role, you'll play an important part in making sure provider disputes and appeals are received, researched, routed, documented, and tracked accurately from start to finish.

This is a great opportunity for someone who understands healthcare claims and enjoys combining research, problem-solving, organization, and administrative support to help providers and internal teams resolve issues efficiently.

What You'll Do

You'll serve as a key point of coordination for incoming provider disputes and appeals, helping ensure each case gets to the right person with the right information and within the required timeframe.

Your Responsibilities

• Receive, review, document, prioritize, and assign incoming provider dispute cases.
• Research incoming disputes and route cases to the appropriate Provider Disputes Specialist or work queue.
• Track cases throughout the dispute process and maintain accurate, up-to-date documentation.
• Research claims, benefits, and authorization information related to provider disputes and appeals.
• Navigate Facets and Jiva to review claims and authorization details.
• Route Medical Appeals, FEP Appeals, correspondence, and internal referrals to the appropriate teams.
• Follow up with internal departments to help ensure claims and benefit issues are addressed accurately and within required timelines.
• Prepare documentation and supporting materials for provider and medical appeal reviews.
• Create and maintain electronic and hard-copy case files.
• Update provider dispute databases, work queues, and case-tracking systems.
• Assist with departmental reporting, committee materials, and ad hoc requests.
• Ensure sensitive member and provider information is handled in accordance with privacy requirements and internal policies.
• Partner with Provider Services, Member Services, Legal, Utilization Management, hospitals, physician offices, and other teams to keep cases moving toward resolution.

What We're Looking ForRequired Qualifications

• High School Diploma or equivalent.
• At least 2 years of medical or health insurance office experience.
• Experience with medical claims processing OR provider/member services.
• Working knowledge of healthcare claims, benefits, or insurance operations.
• Experience with Microsoft Word, Excel, and PowerPoint.
• Strong organizational skills and exceptional attention to detail.
• Ability to manage multiple cases, priorities, and deadlines simultaneously.
• Strong written and verbal communication skills.
• Ability to work independently while collaborating with multiple departments.
• Strong follow-through and commitment to accurate documentation.

What Will Make You Stand Out

• Previous experience with provider disputes or appeals.
• Hands-on Facets experience.
• Experience with Jiva or a similar healthcare authorization/case management platform.
• Payer-side healthcare or health insurance experience.
• Experience researching medical claims and authorizations.
• Provider Services or Provider Relations experience.
• Experience supporting Medical Appeals, Member Appeals, or Provider Appeals.
• Knowledge of healthcare privacy and confidentiality requirements.
• Experience maintaining case databases, work queues, and tracking reports.

Skills That Will Help You Succeed

• Medical Claims Processing
• Provider Disputes & Appeals
• Provider/Member Services
• Claims & Authorization Research
• Facet