Provider Dispute Claims Processor

Job Title: Provider Dispute Claims Processor | In-Office Training Now, Potential for Remote Work Later.

Position Summary:

We are seeking an experienced Provider Dispute Claims Processorthis role is responsible for reviewing, researching, and resolving provider disputes in compliance with regulatory guidelines and internal policies.

The ideal candidate will have hands-on experience with EZCap, and a working knowledge of Medi-Cal and Commercial Insurance Claims.This position plays a critical role in maintaining provider satisfaction and ensuring compliance with dispute resolution timelines.

Compensation Package: PHP 25,000- PHP 30,000

Key Duties:

• Investigate and resolve provider disputes related to denied, underpaid, or incorrectly processed claims
• Utilize EZCap to review claims history, adjudication data, and notes
• Interpret health plan policies, provider contracts, and regulatory requirements (especially Medi-Cal and commercial plans)
• Document findings and resolutions according to compliance standards
• Collaborate with internal teams like Claims, Provider Relations, and Compliance
• Ensure timely dispute resolution within DHCS, DMHC, CMS timeframes
• Identify trends and recommend process improvements

Qualifications:

• High school diploma or equivalent (associate or bachelor's degree is a plus)
• 12 years of provider dispute resolution experience in healthcare, TPA, or health plan settings/ healthcare claims or in a claims processing/adjudication environment
• Hands-on experience with EZCap (strongly preferred)
• Familiarity with Medi-Cal and Commercial insurance claim
• Strong analytical and problem-solving skills
• Excellent verbal and written communication
• Attention to detail in documentation and compliance
• Ability to manage multiple tasks and meet deadlines
• Experience with other claim adjudication platforms and provider systems.
• Familiarity with DHCS, DMHC, CMS dispute handling regulations.

Requirements:

• Proficiency in Microsoft Office (Excel, Outlook, Word)
• Willing to work on shifting schedules, graveyard shift, holidays and weekends if required

Additional Benefits:

• HMO (coverage day 1 plus 1 dependent)
• Paid Time-Off
• Transportation Allowance
• Medical Allowance

COMPANY OVERVIEW:

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.

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.

Imagenet is headquartered in Tampa, operates 10 regional offices throughout the U.S. and has a wholly owned global delivery center in the Philippines.