Dispute resolution specialist job description

Reports to: Dispute Resolution Officer

Functions Supervised: None

Primary Functions: Assist members with fraudulent and merchant dispute transactions on Debit Card, Credit Card and ACH according to federal regulations, VISA and NACHA operating rules, and Credit Union policies and procedures.

Duties and Responsibilities:

Responsible for providing prompt, professional, helpful, knowledgeable and courteous member service. Develop a working knowledge of card and ACH dispute processes and systems. Develop and maintain a current working knowledge of Regulations E, Z and CC as well as Visa and NACHA operating rules and Credit Union policies and procedures. Create, research, and resolve card and ACH dispute cases in accordance with federal regulations, VISA and NACHA operating rules, and Credit Union policies and procedures. Evaluate cases for and provide provisional credit within established limits, as applicable. Research and provide evidence to members to validate unrecognized transactions. Conduct merchant conference calls to resolve product and service problems. Effectively communicate with members to validate information, research cases, and obtain documentation. Respond to inbound and place outbound calls for case creation and member follow-up. Report disputed transactions for possible fraudulent activity and/or trends. Document research findings and actions on cases and conduct referrals for suspicious activity reporting and high dollar case review. Adhere to all designated timeframes, manage workflows to the specified deadlines and complete responsibilities effectively, accurately, and timely. Assist with completing daily reports and MRMS requests. Perform other duties as assigned.

Qualifications

Education: High school graduate or equivalent.

Creditable Experience in Lieu of Education: Not Applicable

Experience/Skills: Must be articulate and possess the ability to communicate with patience and empathy via telephone. Must have detail-oriented writing skills and a strong ability to follow through on assigned tasks. Should be proficient with personal computers, web-based applications, Microsoft Word and Excel, and have strong interpersonal skills, as well as a demonstrated ability to exercise discretionary judgment. One year of previous experience in a similar position or in financial operations is preferred.

Tenure: Dispute Resolution Specialist II, category 13 requires one year tenure in the Dispute Resolution Specialist I category 14 position with performance that meets or exceeds expectations. Dispute Resolution Specialist III, category 12 requires one year tenure in the Dispute Resolution Specialist II category 13 position with performance that meets or exceeds expectations. Senior Dispute Resolution Specialist, category 11 requires one year tenure in the Dispute Resolution Specialist III category 12 position with performance that meet or exceeds expectations. Directly related work experience and/or accelerated training completion may be substituted for tenure.

Equal Opportunity Employer

The primary role of the Resolution Specialist is to resolve provider disputes for Fee Negotiation, Network, Multi-Service and Bill Review & Audit claims; including renegotiating claims if the need arises. Individuals who succeed in this role will demonstrate excellent customer service skills, which include strong verbal and written communication skills. This position will be responsible for metrics such as average time to resolve a dispute, average savings retention, frequency of dispute handling, and accurate documentation; all in an effort to best service our clients and providers. Other requirements involve the delivery of prompt, accurate, and cost-effective service for clients, and to meet or exceed company and client expectations for service. The individual will use problem-solving skills to resolve issues with diplomacy and accuracy.
Key Responsibilities:

+ Research and resolution of provider and client billing inquiries including renegotiating claims as necessary to secure savings, while meeting or exceeding department KPI goals.

+ Maintains tracking of all necessary information related to the research and resolution of assigned work.

+ Works closely with internal staff, including Client Services, Network and Vendor Management, Out of Network Services and Bill Review & Audit for coordinate and promptly resolve issues

+ Assists other department members in resolving complex claims or escalated provider issues.

+ Communicates directly with clients to provide status updates and notification of resolved issues

+ Maintain awareness of and ensure adherence to HIPAA and Zelis standards regarding privacy.

+ Provides coverage and support for the Customer Care Team when needed

+ Performs other related responsibilities as assigned.

Education:

+ High School Diploma

#LI-BG1

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.

Military Veterans are Encouraged to Apply.

Do you enjoy working on a team that sees you as more than just a number? Does teamwork and driving results attract you? Are steady work schedules and work-life balance something you've been missing? If you answered yes to these questions, we may have just the role you are looking for!

What will I be doing?
The Customer Resolution Specialist is responsible for investigating, researching and resolving outstanding Accounts Receivable items that have not been paid due to a customer dispute arising from a billing, shipping or other related type of error.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Evaluate, research and monitor disputed items with internal and external customers.
• Identify payment discrepancies and initiate dispute resolution to facilitate rapid turnaround of payments.
• Contact customers regarding aging accounts due to invoicing discrepancies and disputes for resolution. Demonstrate effective decision making skills and open communication with customers.
• Maintain contact with customers and AR Collectors in order to address and resolve all payment issues timely.
• Monitor and run appropriate SAP reports to monitor Accounts Receivable disputes.
• Corrects errors, including misapplied payments, reversed late charges and over payments.
• Documentation is critical, log conversations, e-mails and other communications. Organize documentation to facilitate follow-up efforts.
• Perform follow-up procedures, as needed, with customers and accounts review.
• Maintain quality relationships with branch managers, account managers and area sales managers.
• Special projects and other duties as assigned.
Qualifications:
What skills and experience do I need to have?
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skills and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• A proven track record of success in prior credit and collection roles, a plus.
• An ability to see the credit operation as a financially oriented customer service function which balances cost control with support for the business.
• The successful candidate must have a strong "client service" mindset and the ability to use collaborative and non-adversarial approaches in achieving diverse goals.
• Good organizational and people skills. The ability to work and navigate within a complex matrixed organization.
• Strong research and investigative skills.
• Strong verbal and written communication and customer service skills and a quality mindset.
• The ability to adapt to a rapidly-changing environment and understand/utilize new technologies and tools.
EDUCATION and/or EXPERIENCE:
• High school diploma or equivalent. Associates degree preferred.
• Minimum two (2) years of commercial collection experience preferred.
• Dispute resolution and call center experience preferred.
• Understanding of quality customer service and the relationship to collection efforts.
• Experience with SAP and/or ERP systems a plus.
• Attention to detail with ability to organize and prioritize workflow.
• Ability to follow instructions and procedures properly in a fast paced work environment.
• Ability to leverage research tools to execute sound decisions.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Able to talk, hear, walk sit; use hands to finger, handle or feel objects, tools, or controls; reach with hands and arms; stoop, kneel or crouch.
• Specific vision abilities to include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus objects.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• The noise level in the work environment is usually moderate and the work environment is an office setting.

Who is Airgas?
Airgas Inc., an Air Liquide company, is one of the country's largest suppliers of industrial, medical and specialty gases. As the leading U.S. distributor, Airgas has a focus on quality products-but we recognize that it's the quality of our people that makes our success possible. With more than 17,000 employees working in approximately 1,100 locations-branches, retail stores, gas fill plants, specialty labs, gas production facilities and distribution centers-chances are, there is a career at Airgas custom fit for you. As the largest supplier of dry ice, Airgas has established a series of production plants across the nation to develop a secure source supply. Distribution Branches are located in strategic locations throughout the country to provide service to key industries including universities and labs. Quality, reliability, and service are the key drivers that enable Airgas to grow with organizations who depend on dry ice and cold shipping supplies.

EOE AA M/F/Vet/Disability
Qualified applicants will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status, or disability