Provider Dispute and Resolution Analyst II

The Provider Dispute and Resolution Analyst II researches, analyzes, and resolves routine to moderately complex provider claims, payment disputes, and reimbursement issues for contracted network providers. This role partners with stakeholders to determine appropriate resolution pathways, validates disputes against contractual rates, and maintains meticulous case records to ensure fair and accurate outcomes. The position involves escalating higher-risk or financially significant disputes to leadership while fostering continuous improvement and accountability within the provider resolution function.