dispute resolution specialist

iMPROve Health

<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><p><b>About iMPROve Health</b></p><p><b>
Come join the iMPROve Health team!</b></p><p>
iMPROve Health is Michigan&rsquo;s Medicare-designated Quality Improvement Organization, and we&rsquo;re proud to be recognized as both a <i>Cool Place to Work</i> by Crain&rsquo;s Detroit Business (four years running) and one of <i>Modern Healthcare&rsquo;s Best Places to Work in Healthcare</i>.</p><p>
As a nonprofit with more than 40 years of experience, we&rsquo;re dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: <b>help healthcare get better.</b></p><p>
This position is <b>100% remote</b>, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees&rsquo; growth through professional development and continuing education opportunities. Our benefit package includes medical, dental, vision, life insurance, short- and long-term disability, and a generous 401(k) match.</p><p>
At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals&mdash;including physicians, nurses, and experienced consultants&mdash;partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.</p><p>
Join us in making a meaningful impact on healthcare&mdash;one improvement at a time.</p><p><b>
SUMMARY:</b></p><p>
The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR/IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of all necessary review documentation.</p><p><b>
DUTIES AND RESPONSIBILITIES:</b></p><ul><li>
Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.</li><li>
Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.</li><li>
Apply knowledge and experience in <b>claims, appeals, and denials</b> to support review and resolution processes, ensuring accuracy, compliance, and timeliness.</li><li>
Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.</li><li>
Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.</li><li>
Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.</li><li>
Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.</li><li>
Utilize advanced computer skills for daily work; responsibilities require <b>constant computer usage</b> and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.</li><li>
Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.</li><li>
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare &amp; Medicaid Services, Federal Acquisition Regulation (FAR)).</li><li>
Complete other duties as assigned</li></ul><p><b>
EDUCATION AND/OR EXPERIENCE:</b></p><ul><li>
Associate&rsquo;s degree or five (5) years of related experience required; Bachelor&rsquo;s degree preferred (healthcare specialty preferred).</li><li>
Minimum two (2) years of project support experience in a corporate or professional environment required.</li><li>
Experience in <b>IDR or claims, appeal, and denial processes</b> preferred.</li><li>
Project management skills required.</li><li>
Strong communication skills, both verbal and written, required.</li><li>
Strong multi-tasking skills with attention to detail and deadlines required.</li></ul><p><b>
CORE COMPETENCIES:</b></p><p>
Attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving.</p><p>
This is a fully remote opportunity.</p><p></p><p><b><br>
EOE/VET/Disability</b></p></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><br>
Monday - Friday 8 am to 5 pm EST</div>

PROJECT SPECIALIST - HEALTHCARE - REMOTE

Hilco Global

<p></p><div><p><b>Company Overview
</b></p><p></p><p>Hilco Global, a subsidiary of ORIX Corporation USA, is a diversified financial services company that delivers integrated professional services and capital solutions that help clients maximize value and drive performance across the retail, commercial and industrial, real estate, manufacturing, brand and intellectual property sectors, and more. Hilco Global provides a range of customized solutions to healthy, stressed, and distressed companies to resolve complex situations and enhance long-term enterprise value. Hilco Global works to deliver the best possible result by aligning interests with clients and providing strategic advice and, in many instances, the capital required to complete the deal. Hilco Global is based in Northbrook, Illinois and has more than 850 professionals operating on four continents. Visit www.hilcoglobal.com .
</p><p></p><p><b>What differentiates Hilco </b>is the strength and breadth of its platform. The firm is trusted in high-stakes, complex, and often time-sensitive situations where financial, operational, strategic, and legal issues intersect. Hilco brings together deep experience, commercial judgment, and execution capability across the business lifecycle &mdash; from healthy companies seeking growth or strategic alternatives to stressed and distressed situations requiring decisive action.
</p><p></p><p>Built on that foundation, Hilco Global is expanding its <b>Global Investigations &amp; Dispute Resolution </b>practice. This growing practice advises clients on matters involving fraud and misconduct investigations, forensic accounting and financial analysis, post-acquisition and other commercial disputes, bribery and corruption matters, asset tracing, investigative due diligence, litigation support, regulatory response, and other sensitive situations requiring rigorous analysis, sound judgment, and clear communication.
</p><p></p><p>This is not a standalone niche practice being built in isolation. It is being developed within a powerful platform that already has deep client relationships, strong market credibility, and meaningful adjacency to restructuring, valuation, capital solutions, and other advisory capabilities. For the right professionals, that creates a rare opportunity: the chance to build within an established platform that already matters in the market.
</p><p></p><p><b>Why Hilco Global
</b></p><p>There are many firms that offer investigations and disputes work. Very few offer the combination of platform strength, market relevance, entrepreneurial upside, and cross-disciplinary opportunity that Hilco does.
</p><p></p><p>Joining Hilco&rsquo;s Global Investigations &amp; Dispute Resolution practice means joining at a time of strong momentum. The practice is being actively built and expanded, with the benefit of Hilco&rsquo;s broader brand, relationships, and capabilities across capital solutions, restructuring, valuation, advisory, and special situations.
</p><p></p><p>For professionals who are ambitious, commercial, and excited by the idea of helping shape a market-facing practice, Hilco offers a differentiated proposition:
</p><ul><li>A powerful platform behind the practice, with meaningful credibility and access across lenders, investors, boards, law firms, and corporate clients
</li><li>A true build opportunity &mdash; the chance to help shape a leading global investigations and disputes offering, not simply join a mature team with limited room to influence direction
</li><li>Complex, high-value matters at the intersection of accounting, finance, disputes, investigations, transactions, restructurings, and distressed situations
</li><li>Cross-platform opportunity, with natural adjacency to Hilco&rsquo;s capital solutions, restructuring, valuation, and advisory capabilities
</li><li>Meaningful responsibility and career upside for professionals who combine technical excellence, sound judgment, and initiative
</li></ul><p></p><p>At Hilco, professionals are not joining a static organization. They are joining a platform with real market strength and the ambition to build a premier practice.
</p><p></p><p><b>Position Overview
</b></p><p>As an Analyst in Hilco Global Investigations &amp; Dispute Resolution practice, you will support engagement teams on a range of investigative, forensic accounting, financial analysis, and dispute-related matters. You will work closely with more senior professionals to conduct research, analyze documents and data, organize facts, and assist in developing client-ready work product.
</p><p>This role is ideal for an early-career professional who wants to build a strong foundation in investigations, disputes, financial analysis, and advisory work while gaining exposure to complex, high-stakes matters across industries and situations.
</p><p></p><p><b>Key Responsibilities
</b></p><ul><li>Support investigations and dispute-related engagements through research, document review, financial analysis, and fact development
</li><li>Conduct public records, open-source, media, and database research on individuals, companies, transactions, and counterparties
</li><li>Assist in collecting, organizing, and analyzing accounting, financial, operational, and transactional records
</li><li>Prepare workpapers, chronologies, schedules, issue summaries, and other materials used in client engagements
</li><li>Contribute to reports, memoranda, presentations, and internal briefing materials
</li><li>Assist in identifying relevant fact patterns, inconsistencies, red flags, and investigative leads
</li><li>Coordinate with engagement teams on workstreams, deadlines, and quality control
</li><li>Participate in internal training, research, and practice initiatives as needed
</li></ul><p></p><p><b>Desired Qualifications
</b></p><ul><li>Bachelor&rsquo;s degree in accounting, finance, economics, business, or a related discipline required; candidates with master&rsquo;s degrees (e.g., MAcc, MBA, MSF, or similar) are strongly encouraged and will be prioritized
</li><li>0&ndash;2 years of relevant experience in consulting, audit, investigations, compliance, risk, financial analysis, or related areas
</li><li>Strong analytical, organizational, and problem-solving skills
</li><li>Strong attention to detail and ability to work effectively in a deadline-driven environment
</li><li>Effective written and verbal communication skills
</li><li>Proficiency in Microsoft Excel, Word, and PowerPoint
</li><li>Exposure to investigative databases, financial research tools, e-discovery platforms, or analytics tools is a plus
</li><li>Interest in developing toward professional credentials such as CPA, CFE, CAMS, CFA, CFF, or similar certifications is beneficial
</li><li>High level of initiative, professionalism, intellectual curiosity, and commitment to quality
</li></ul><p></p><p>Candidates are expected to onsite at Hilco Global offices and work primarily in person with their teams. Travel may be required depending on client needs and engagement demands.
</p><p></p><p><b>Work Arrangement
</b></p><p>Hilco Global believes that complex advisory work benefits from collaboration, mentorship, and real-time problem solving. As such, professionals in the Global Investigations &amp; Dispute Resolution practice are expected to work primarily from the office, collaborating closely with their teams and colleagues across Hilco&rsquo;s broader platform.
</p><p></p><p>While flexibility may be available when business needs permit, the practice operates as an office-based team environment to support high-quality client service, professional development, and team cohesion.
</p><p></p><p><i>Annual base salary gross: $90,000-115,000. The base salary range represents the estimated low and high end of Hilco&rsquo;s salary for this position based on geography. Actual base salaries will vary and will be based on various factors, such as candidate&rsquo;s qualifications, skills, competencies and proficiency for the role. The base pay is one component of Hilco&rsquo;s total compensation package for employees. Other rewards and benefits include cash bonuses, long term incentives, health insurance, accident and life insurance, and retirement benefits.
</i></p><p></p><p>Hilco Global is an equal opportunity employer. Qualified candidates will be considered on merits and without regard to race, religion, color, national origin, sexual orientation, genetic information, marital status, gender, veteran, or disability status.
</p><p></p><p>Hilco Global strives to comply with all applicable local/state regulations regarding displaying salary ranges. Any offered salary is determined based on relevant factors such as applicant's skills, job responsibilities, prior relevant experience, certain degrees and certifications and market considerations. In addition, Hilco Global is proud to offer a comprehensive, competitive benefits package, with options designed to help you make the best decisions for yourself, your family, and your lifestyle. Available benefits are based on eligibility. Our Total Rewards package includes a variety of medical and dental plans, vision coverage, disability and life insurance, 401(k) plans, and a robust suite of personal well-being benefits to support your mental health. https://hilcoglobal.com/careers-about/</p></div><p></p>

Analyst, Global Investigations & Dispute Resolution

Dispute Resolution Lawyer

Caloptima

<div><div><b>Grievance Resolution Specialist Sr (Provider Resolution)</b><br>
<br>
<b>CalOptima</b></div><br>
<b>
Join Us in this Amazing Opportunity</b><br>
<br>
<b>The Team You'll Join</b><br>
<br>
We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.<br>
<br>
<b>More About the Opportunity</b>
<br>
<br>
We are hoping you will join us as a <b>Grievance Resolution Specialist Sr (Provider Resolution)</b> and help shape the future of healthcare where you'll be an integral part of our <b>Grievance &amp; Appeals </b>team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be <b>Full Telework</b>.
<br>
<ul><li><i>If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.</i>
</li></ul><br>
You will coordinate the overall process of complaint resolution, responding to all verbal and written complaints from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, pharmacy and vision decisions. You will have frequent external contact with members and families, health care providers, organizations and regulators. In addition, you will frequently interact with internal contacts in Claims Administration, Customer Service, Provider Relations, Contracting, Pharmacy Management, Third-Party Administrators, Medical Management, health networks and other resources to identify the factors necessary for optimal resolution of complaints. You will be responsible for processing complex cases requiring additional research or problem-solving. You will process 1st and 2nd Level provider appeals in accordance with Department of Health Care Services (DHCS) and Centers for Medicare &amp; Medicaid Services (CMS) guidelines and regulations. Together, we are building a stronger, more equitable health system.
<br>
<br>
<b>Your Contributions To the Team:</b>
<br>
<ul><li>75% - Program Support
<ul><li>Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.</li>
<li>Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.</li>
<li>Develops and maintains adequate information systems to assure timely and effective data collection, summarization, integration and reporting, including case creation, management and events/activity tracking.</li>
<li>Ensures compliance with CalOptima Health's Grievance Policy and timely case resolution, initiates and coordinates referrals to the Quality Improvement department as necessary and facilitates response to members according to policy.</li>
<li>Handles escalated issues from providers, as well as internal and external customers.</li>
<li>Gathers pertinent information regarding complaints, including member or provider concerns, claims payments, billing reimbursements, supporting information related to initial decisions, new information supporting complaints and supplemental information required to evaluate complaints and regulatory requirements.</li>
<li>Coordinates and participates in case discussions with operational experts to result in a final case disposition.</li>
<li>Reviews government claim cases and determines resolution and recommendation based on researched claims, Provider Dispute Resolution (PDR) and 2nd Level appeal analyses.</li>
<li>Evaluates case details related to member or provider complaints and makes appropriate decisions based on information provided and research conducted.</li>
<li>Provides a summary of GARS cases requested by Legal Affairs or other departments.</li>
<li>Provides subject matter expertise and trains new and existing staff as needed.</li>
<li>Assists with case assignment, assumes cases assignments per business needs and monitors the daily operations for member and provider complaints, ensuring compliance with the implementation of the decision.</li>
<li>Contacts appropriate parties to request and obtain missing information and supporting documentation or provides education.</li>
<li>Oversees resolution letters for accuracy of information and appropriate decisions.</li>
<li>Meets performance measurement goals for GARS.</li>
Supports with provider appeals audits by reviewing findings, gathering and organizing requested materials and completing rebuttals.<br>
<li>
<br>
<br>
</li></ul></li><li>20% - Administrative Support
<ul><li>Participates in meetings regarding case assignment issues and collaborates with cross-department teams to maintain current knowledge of organizational processes and guidelines to effectively resolve cases.</li>
<li>Reads and interprets provider contracts, Division of Financial Responsibility (DOFR), policies, procedures and instructions.</li>
<li>Responds to routine provider inquiries via phone and assists with provider appeals resolution inquiries.</li>
<li>Tracks and trends provider appeals and claims issues.</li>
Supports all department initiatives in improving overall efficiency.<br>
<li>
<br>
<br>
</li></ul></li><li>5% - Completes other projects and duties as assigned.
</li></ul><br>
<b>Do You Have What the Role Requires?</b><br>
<ul>
<li>High school diploma or equivalent PLUS 3 years of experience with Provider Non-Contracted Medicare Post-Service appeals and denials required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.<br>
</li>
<li>3 years of experience with PDR in Medicare and Medi-Cal in Professional, Institutional, Outpatient, Ancillary, Coordination of Benefits and Government Cases required.
<br>
</li><li>Experience with Medicare or Medi-Cal provider appeals and denials process required.<br>
</li>
<li>Experience in health care practice standards, for both government and commercial plans required.<br>
</li>
<li>Experience with claims administration required.</li>
</ul><br>
<b>You'll Stand Out More If You Possess the Following:</b><br>
<ul>
<li>Associate's degree in health care administration or related field.<br>
</li>
<li>Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Russian, Spanish, Vietnamese).</li>
</ul><br>
<b>What the Regulatory Agencies Need You to Possess?</b><br>
<ul>
<li>N/A</li>
</ul><br>
<b>Your Knowledge &amp; Abilities to Bring to this Role:</b><br>
<ul>
<li>Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
</li><li>Work independently and exercise sound judgment.</li>
<li>Communicate clearly and concisely, both orally and in writing.</li>
<li>Work a flexible schedule; available to participate in evening and weekend events.</li>
<li>Organize, be analytical, problem-solve and possess project management skills.</li>
<li>Work in a fast-paced environment and in an efficient manner.</li>
<li>Manage multiple projects and identify opportunities for internal and external collaboration.</li>
<li>Motivate and lead multi-program teams and external committees/coalitions.</li>
<li>Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.</li>
</ul><br>
<b>Your Physical Requirements (With or Without Accommodations):</b><br>
<ul>
<li>Ability to visually read information from computer screens, forms and other printed materials and information.</li>
<li>Ability to speak (enunciate) clearly in conversation and general communication.</li>
<li>Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.</li>
<li>Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.</li>
<li>Lifting and moving objects, patients and/or equipment 10 to 25 pounds</li>
</ul><br>
<b>Ways We Are Here For You</b><br>
<ul>
<li>You'll enjoy competitive compensation for this role.
<ul><li>Our current hiring range is: Pay Grade: <b>306 - $58,205 - $90,217 ($27.98 - $43.3736).
</b><ul><li><b><i>The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.</i></b><br>
</li>
</ul></li></ul></li><li>This position is approved for <b>Full Telework </b><i>(**If the position is Telework, it is eligible in California only**)</i>
</li><li>A <b>comprehensive benefits package</b>
</li><li>CalPERS pension program and additional retirement packages.
</li><li>Additional benefits and perks including:
<ul><li>A generous PTO program</li>
<li>A quality work life balance</li>
<li>Various wellness programs</li>
<li>Tuition Reimbursement</li>
<li>Professional development opportunities</li>
<li>Career development opportunities</li>
<li>Flexible scheduling</li>
<li>And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.</li>
</ul></li></ul><br>
<b>Our Work Environment:</b><br>
<br>
If located at the 500, 505 Building or a remote work location:<br>
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.</li>
<li>There are no harmful environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate.</li>
</ul><br>
If located at PACE:<br>
<ul>
<li>Work is typically indoors in a clinical setting serving the frail and elderly.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul><br>
If located in the Community:<br>
<ul>
<li>Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
</li><li>Employee will occasionally work outdoors in varied temperatures.</li>
<li>There may be harmful or hazardous environmental conditions present for this job.</li>
<li>The noise level in this work environment is usually moderate to loud.</li>
</ul><br>
<b>Why Join Us?</b><br>
<br>
We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.<br>
<br>
<b>What's Your Next Step?</b><br>
<br>
All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is <b>April 1, 2026 at </b><b>9:00 PM (PST). </b><b>We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.</b>
<br>
<br>
<b>Our Commitment to You</b><br>
<br>
<b>Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.</b><br>
<br>
If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.<br>
<br>
We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.
<br>
<br>
<i>CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.</i><br>
<br>
<i>CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.</i><i>
</i><br>
<br>
<i>If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.</i><br>
<br>
<b>To apply, please visit: </b><b>https://jobs.caloptima.org/jobs/grievance-resolution-specialist-sr-provider-resolution-505-city-parkway-west-california-united-states</b><br>
<br>
jeid-9f97bae4154ec349812fc00e682610dd</div>

Grievance Resolution Specialist Sr (Provider Resolution)

FNBO - First National Bank of Omaha

<div><div>At FNBO, our employees are the heart of our story&mdash;and we&rsquo;re committed to their success! Please see below the details of this career opportunity and how it fits into our organization&rsquo;s success.</div><div></div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div>
Summary of the Job:</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div><br>
<div></div>
At FNBO, we believe that a bank should be a force for good in the world. And to us, that means doing right by our customers, our employees and our communities day in and day out. As a Fraud and Non-Fraud Investigations Senior Specialist, you can do just that by helping FNBO customers protect themselves against fraud as well as assisting with billing disputes.<br>
<br>
We are looking for someone who will share our excitement about the opportunity to investigate, analyze and immerse yourself in the world of credit card investigations. Our mission is to support our customers who have been victims of fraud as well as those who have had billing disputes on purchases they have made.<br>
<br>
In the Fraud and Non-Fraud Investigations Department, we wouldn&rsquo;t call our jobs easy, but we would call them rewarding. If you are a strategic problem solver who enjoys a challenge with a rewarding payoff, join us. We will provide the support and training needed to help you become a well-versed Investigations Specialist who can make a big difference to our customers&rsquo; financial lives.<div></div><div>
About This Role:</div><div></div><div><br>
As a Fraud and Non-Fraud Investigations Specialist at FNBO, you will be expected to:</div><ul><li>
Communicate with customers who have experienced fraud or a billing error on their account while also reassuring these vulnerable customers that FNBO has their back</li><li>
Determine the validity of disputes and hold customers accountable if necessary</li><li>
Conduct an in-depth investigation and attempt to identify a suspect</li><li>
Contact law enforcement when necessary and provide important information</li><li>
Research and submit Suspicious Activity Referrals when necessary</li><li>
Understand chargeback life cycles for Visa and Mastercard</li><li>
Review responses from merchants and respond accurately and professionally based on the information that was provided.</li><li>
Understand Federal Regulation Z and ensure that all work is completed to the standard that is set forth</li><li>
Perform basic accounting and ensure that customer&rsquo;s accounts balance after an investigation is complete</li><li>
Assist the Bankcard Recovery department by investigating claims of fraud and billing disputes on accounts in collections</li><li>
Effectively manage time to ensure performance is meeting or exceeding production goals.</li></ul><div></div><div>
The Ideal Candidate for This Role:</div><div></div><div><br>
THE IDEAL CANDIDATE FOR THIS ROLE IS&hellip;</div><ul><li>
Supportive and solution-oriented</li><li>
A strategic thinker</li><li>
Strong written and oral communication skills and comprehension</li><li>
A person who believes in a greater mission</li><li>
Someone who takes pride in doing good for the community</li><li>
Great at managing multiple responsibilities</li><li>
Comfortable defusing a potentially stressful situation</li><li>
Motivated by a challenge</li></ul><div></div><div>
EXPERIENCE AND BACKGROUND</div><div></div><div>
Required:</div><ul><li>
High school diploma or GED</li><li>
Excellent oral and written communication skills</li><li>
Basic PC skills required with the ability to master the software programs we use (FileNet, TBS, CRT, etc.)</li><li>
A minimum of nine months of customer service experience</li><li>
Basic accounting skills with the ability to balance accounts</li></ul><div></div><div>
Desired:</div><ul><li>
Credit card dispute and chargeback experience is highly desired</li><li>
Familiarity with the credit card or banking industry</li></ul><div></div>
Candidates must possess unrestricted work authorization and not require future sponsorship.<div></div><div>
Compensation:</div><br>
<div></div>
Compensation range (base pay): $37,454.00-$59,927.00<div><i>
This role may have a specific starting pay within this range.</i></div><div></div><div>
Final compensation offer to candidate may vary from posted hiring range based upon work experience, education, and/or skill level.</div><div></div><div>
Work Environment:</div><div></div>
It is anticipated that the incumbent in this role will work onsite during the initial training period. After training is complete, the incumbent may be able to transition to remote work, offering you the freedom to contribute to our mission from wherever you work best, without compromising on career growth or connection to our team. Regardless of your location, you'll be fully integrated into our team through robust digital collaboration tools and regular communication. Please note, work location and onsite duration requirement is subject to change based on business needs.<div></div><div>
Benefits Overview:</div><div></div><div>
We offer a variety of benefits designed to keep you and your family physically and financially healthy. Not only do we offer a competitive salary and work-life balance, we offer benefits to match your needs:</div><ul><li><div>
Medical, Dental, Vision Insurance</div></li><li><div>
401k, With Matching Contributions</div></li><li><div>
Time Off Programs</div></li><li><div>
Health Savings Account (HSA)/Dependent Care</div></li><li><div>
Employee Banking</div></li><li><div>
Growth Opportunities</div></li><li><div>
Tuition Assistance</div></li><li><div>
Short-Term/Long-Term Disability Insurance</div></li></ul><div></div><div>
Learn more about FNBO benefits here: <div>https://www.fnbo.com/careers/benefits/</div>.</div><div></div><div>
For additional information regarding compensation and benefits, e-mail FNBO at <div>TAGAdmin@fnni.com</div>. To ensure you receive a response, include the number of this job (listed below) in the subject line of your message.</div>
Job number: R-20260454<div></div><div>
Equal Opportunity &amp; Belonging:</div><div></div><div>
FNBO believes that the quality of our employee experience is at the heart of our customer experience. One key pillar of our intended employee experience is Belonging. Belonging means we are committed to fostering a workplace culture where employees of all backgrounds feel valued, recognized, and empowered to be their authentic selves&mdash;no matter their role or where they are in their journey.</div><div></div><div><div>
Learn more here.</div></div><div></div><div>
FNBO is an equal opportunity employer for all employees and applicants and makes employment decisions without regard to status or identity.</div><div></div><div><br>
FNBO is an Equal Opportunity/Affirmative Action/Veterans/Disability Employer - Member FDIC</div><div>
FNBO follows federal law regarding the use of marijuana<i> (this applies to all non-California applicants)</i></div><div></div><div>
Application Deadline:</div><div></div><div>
All our jobs will be posted for a minimum of 5 calendar days. Job postings may come down prior to 5 calendar days based on volume of applicants.</div></div>

Sr. Specialist, Fraud & Non Fraud Investigations

TriStar Health

<p></p><div><h5 class="jobSectionHeader"><b>Introduction</b></h5><p></p><p>
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA).</p><p>
Do you want to join an organization that invests in you as a Claims Resolution Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years.</p><p></p><h5 class="jobSectionHeader"><b>
Benefits</b></h5><p>
Parallon offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:</p><ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing<br>
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)<br>
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock<br>
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance.<br>
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more<br>
</li><li>
Consumer discounts through Abenity and Consumer Discounts<br>
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships<br>
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships)<br>
</li><li>
Colleague recognition program<br>
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)<br>
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul><p>
Learn more about Employee Benefits</p><p><b><i>
Note: Eligibility for benefits may vary by location.</i></b></p><p><br>
You contribute to our success. Every role has an impact on our patients&rsquo; lives and you have the opportunity to make a difference. We are looking for a dedicated Claims Resolution Specialist like you to be a part of our team.</p><h5 class="jobSectionHeader"><b>
Job Summary and Qualifications</b></h5><p></p><p><br>
The Claims Resolution Specialist is responsible for applying fundamental knowledge of healthcare revenue cycle practices and procedures as it relates to researching, analyzing, and resolving open insurance claims and balances. This job requires regular outreach to payors.<br>
 </p><br>
<p>In this role you will:</p><br>
<p></p><ul><li>
Conduct follow-up with payors, vendors, and clearinghouse on open insurance claims and balances in compliance with departmental policies and procedures</li><li>
Resubmit primary and secondary claims</li><li>
Identify potential claim issues and escalate to management</li><li>
Review, identify, and resolve payor denials</li><li>
Update patient accounts as appropriate</li><li>
Ensure adjustments are posted timely and correctly for claims that need to be adjusted</li><li>
Resolve claims impacted by payor recoupments and refunds Meet and maintain established departmental performance metrics for production and quality</li><li>
Maintain working knowledge of workflow, systems, and tools used in the department</li></ul><p></p><p><br>
 Qualifications:</p><br>
<p></p><ul><li>
Minimum one-year related healthcare experience preferred.</li><li>
Relevant education may substitute experience requirement.</li><li>
Previous Call Center experience is preferred</li><li>
Virtual employees are required to have high speed wired internet speed 25 MBS Download and 6 MBS Upload</li></ul><p></p><p><b><br>
Parallon</b> provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.</p><p></p><p>
HCA Healthcare has been recognized as one of the World&rsquo;s Most Ethical Companies&reg; by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.</p><p>
&quot;</p><p></p><p><br>
&quot;Good people beget good people.&quot;- Dr. Thomas Frist, Sr.<br>
HCA Healthcare Co-Founder</p>
<p>We are a family 270,000 dedicated professionals! Our Talent Acquisition team is reviewing applications for our Claims Resolution Specialist opening. Qualified candidates will be contacted for interviews. <b>Submit your resume today to join our community of caring!</b></p><p><i>
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</i></p></div>

Claims Resolution Specialist

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