Job Description
Position Purpose: Research and resolve claims disputes coming from Participating providers.
Responsibilities:
+ Research and resolve claim disputes by navigating company’s claims system and multiple platforms
+ Ensure timely, efficient, accurate and compliant resolution of claim disputes
+ Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes
+ Identify opportunities to improve claims processing, and reduce risk and inefficiency
+ Review claim dispute reports for data integrity and perform necessary updates
+ Perform data entry of claims disputes
+ Handle provider telephone calls and e-mails regarding the status of claim disputes
+ Work with the Provider Relations team and support claim dispute escalations
+ Communicate with internal departments as required
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Responsibilities:
+ Research and resolve claim disputes by navigating company’s claims system and multiple platforms
+ Ensure timely, efficient, accurate and compliant resolution of claim disputes
+ Research provider contract, fee-schedules, claim rules, correct application of benefits, prior authorizations and member eligibility as they relate to claim disputes
+ Identify opportunities to improve claims processing, and reduce risk and inefficiency
+ Review claim dispute reports for data integrity and perform necessary updates
+ Perform data entry of claims disputes
+ Handle provider telephone calls and e-mails regarding the status of claim disputes
+ Work with the Provider Relations team and support claim dispute escalations
+ Communicate with internal departments as required
<...
Ready to Apply?
Submit your application today and join our talented team at DOCTORS HEALTHCARE PLANS, INC..
Submit ApplicationJob Details
- Location Coral Gables, FL
- Job Type Full-time
- Category other-general
- Posted Date July 06, 2026
- Application Deadline July 11, 2026