Lead the execution of pricing dispute resolution activities within Voluntary Out-of-Network cost containment programs
Conduct thorough investigations of pricing disputes to determine appropriate next steps, involved vendors, and resolution pathways
Ensure timely follow-up and resolution in alignment with established turnaround time standards
Maintain accurate, detailed documentation and tracking of all dispute cases
Support external claims pricing dispute resolution by working directly with vendors, providers, and internal stakeholders to ensure accurate pricing methodologies are applied and disputes are resolved efficiently
Serve as a knowledgeable point of contact for internal stakeholders, vendors, and providers
Provide guidance and feedback to Claims and Call Center teams related to dispute resolution processes
Demonstrate professionalism and a strong commitment to customer satisfaction in all interactions
Compile and analyze data to identify trends, gaps, and opportunities for improvement
Support the development of reports and tools used to monitor program performance
Contribute to process improvement initiatives and support operational change efforts

Bachelor’s degree preferred but not required; equivalent experience in healthcare operations, claims, provider contracting, or analytics will be considered
Minimum of 3 years of experience in claims, call center operations, healthcare analytics, or provider contracting
Strong written and verbal communication skills
Advanced proficiency in Microsoft Excel and other data analysis tools
Ability to work independently while managing multiple priorities effectively
Customer-focused mindset with a strong commitment to quality and timeliness
Strong analytical, critical-thinking, and problem-solving skills
Ability to influence peers and support operational change initiatives

Senior Analyst, Provider Contracting – Voluntary Out-of-Network Pricing

Key skills