Provider Dispute Claims Processor

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    "datePosted": "2026-05-30",
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    "description": "<p><span style=\"color: rgb(0, 0, 0); font-size: 12pt\"><span style=\"font-weight: bold\">Job Title: <span style=\"font-family: Inter, sans-serif\"><span style=\"font-weight: 400\"><span style=\"font-weight: bold\">Provider Dispute Claims Processor | </span></span></span></span></span><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\"><span style=\"color: rgb(0, 0, 0)\">Potential for Remote Work After Training</span><br><br></span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\"><br></span></span></p>\n<p><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Work Setup:</span><span> </span>In‑Office Training Required</span><br><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Location:</span><span> </span>Makati – Valero</span><br><span style=\"font-size: 12pt\"><span style=\"font-weight: bold\">Schedule:</span><span> </span>Monday to Friday (Day Shift, Shifting Hours)</span><br></p>\n<p><br></p>\n<p><span style=\"color: rgb(27, 43, 59); font-size: 12pt; font-weight: bold\">Expected Start Date: June 15, 2026 </span></p>\n<p><span style=\"color: rgb(27, 43, 59); font-size: 12pt; font-weight: bold\">We will prioritize those who can commit and start ASAP</span></p>\n<p><br></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Position Summary:</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><span style=\"font-weight: 400\">We are seeking an experienced <span style=\"font-weight: bold\"><span style=\"font-weight: 400\"><span style=\"font-weight: bold\">Provider Dispute Claims Processor</span></span></span> this role is responsible for reviewing, researching, and resolving provider disputes in compliance with regulatory guidelines and internal policies. </span></span></span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><span style=\"font-weight: bold\">The ideal candidate will have hands-on experience and knowledge of Medi-Cal and Commercial Insurance Claims.</span><span style=\"font-weight: 400\"><br></span></span></span></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><br></span></span><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-weight: bold\"><span style=\"font-weight: 400\">This position plays a critical role in maintaining provider satisfaction and ensuring compliance with dispute resolution timelines.</span></span></span></p>\n<p><br></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Key Duties:</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">Utilize EZCap to review claims history, adjudication data, and notes</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">Interpret health plan policies, provider contracts, and regulatory requirements (especially Medi-Cal and commercial plans)</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Reviewed healthcare claims for accuracy and compliance, ensuring timely resolution across multiple specialties.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Evaluated authorization details and validated codes to ensure claim approval and compliance.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Detected discrepancies that led to appropriate claim denials or adjustments, reducing erroneous payments.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Collaborated with internal quality auditors, resulting in a 15% improvement in claims accuracy within the first year.</span><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Process and review healthcare claims across multiple specialties (Anesthesia, ARI, DME, Facility, MSK, Surgery, PAP Supplies, COB, and Lab).</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Verify eligibility, coverage, CPT codes, and supporting documentation for both Primary and Secondary Medicare claims.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Identify discrepancies and determine whether to approve, deny, or adjust claims per policy guidelines and medical necessity.</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Maintain <span style=\"font-weight: bold\">98%+ accuracy</span> in claims adjudication while consistently meeting turnaround time (TAT) and quality assurance standards.</span></li>\n</ul>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Required Qualifications:</span></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0)\">High school diploma or equivalent; associate or bachelor’s degree is a plus.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\"><span style=\"font-weight: bold\">At least 3–5 years </span>of hands-on experience in provider dispute resolution within healthcare, third-party administrator (TPA), or health plan settings, including claims processing and adjudication.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Proficient in CPT, ICD-10, and HCPCS coding validation; experienced in handling Medicare claims and secondary coverage.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Skilled in claims denials, adjustments, and appeals processes, strong knowledge of authorization and eligibility verification.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Familiar with HIPAA, data privacy regulations, and basic cybersecurity standards.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Strong background in data analysis and visualization to identify trends, improve workflows, and support decision-making.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Claims Adjudication Systems: Experienced with platforms such as IDX and Facets.</span></li>\n<li><span style=\"color: rgb(0, 0, 0)\">Tools: Proficient in Microsoft Office Suite (Excel, Outlook, Word), with advanced Excel skills.</span></li>\n<li>Can start ASAP.</li>\n</ul>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"> </span><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Requirements &amp; Work Arrangement: </span><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"> </span></p>\n<ul></ul>\n<ul>\n<li><span style=\"font-size: 12pt; font-weight: bold\">Can start ASAP. This is an urgent hiring.</span><br></li>\n<li><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\"><span style=\"font-size: 12pt\"><span style=\"font-family: Inter, sans-serif\"><span style=\"font-weight: bold\">Work Arrangement:</span> </span><span style=\"font-weight: bold\">This position is currently offered on a remote work basis after successful completion of training (In-office)</span>. However, please note that this is a performance-based role, and the company reserves the right to require employees to report onsite at any time based on business needs, performance evaluations, operational requirements. Flexibility to transition to an office-based setup when necessary is expected.</span></span></li>\n</ul>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">Additional Benefits:</span><br></p>\n<ul>\n<li><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">HMO - Medical &amp; Dental (coverage on Day1 plus 1 dependent)</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Transportation Allowance</span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Internat Allowance<span style=\"font-family: Inter, sans-serif\"><br></span></span></li>\n<li><span style=\"color: rgb(0, 0, 0); font-size: 12pt\">Equipment will be provided</span></li>\n</ul>\n<p><br></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt; font-weight: bold\">COMPANY OVERVIEW:</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">Imagenet is a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide. Imagenet provides claims processing services, including digital transformation, claims adjudication and member and provider engagement services, acting as a mission-critical partner to these plans in enhancing engagement and satisfaction with plans’ members and providers. </span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">The company currently serves over 70 health plans, acting as a mission-critical partner to these plans in enhancing overall care, engagement and satisfaction with plans’ members and providers.  The company processes millions of claims and multiples of related structured and unstructured data elements within these claims annually.  The company has also developed an innovative workflow technology platform, JetStreamTM, to help with traceability, governance and automation of claims operations for its clients.</span></p>\n<p><br></p>\n<p><span style=\"color: rgb(0, 0, 0); font-family: Inter, sans-serif; font-size: 12pt\">Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.</span></p>",
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