You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a highly organized, process-driven Dispute Resolution Specialist to manage and administer out-of-network health insurance claim payment disputes. In this role, you will lead efforts to resolve underpaid medical claims by guiding them through the federal Independent Dispute Resolution (IDR) process established by the No Surprises Act. This involves managing a consistent flow of disputes and handling key responsibilities within tight federal timelines.

Key Responsibilities

• Evaluate incoming denied or underpaid medical claims to determine eligibility for the federal No Surprises Act process.
• Gather and compile all necessary case documentation, including medical records and Explanations of Benefits (EOBs).
• Actively track and monitor strict statutory deadlines to ensure no filing windows or open negotiation periods are missed.
• Package complete dispute files and submit them directly through the federal government’s CMS portal.
• Follow up on arbitrator decisions, coordinate administrative fee details, and track accounts receivable to ensure finalized payments are received.

Qualifications

• College degree (Bachelor’s degree) or Paralegal Certificate
• Strong, hands-on experience using Salesforce to manage pipelines, update file statuses, and track complex workflows.
• Professional proficiency in Microsoft Office, especially Excel and Word.
• Exceptional organizational skills with a proven ability to manage high-volume data and paperwork without losing track of details.

Skills

• Certified Paralegal credential (not required, but a strong plus).
• Prior experience navigating the CMS federal IDR portal (strong plus).
• Background in healthcare administration, health insurance claims, or medical billing (familiarity with EOBs or basic medical coding).

Schedule

• Monday through Friday, 8:00 AM start time (exact schedule is flexible).
• Standard 8-to-9 hour shift during traditional business hours, with flexibility to start early and finish early.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

This role is contingent upon passing any applicable background checks and following any regulatory compliance as required.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

Any required state or Joint Commission training is compensated at the state or local minimum wage rate.

^*As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.