Provider Dispute & Adjustment Specialist

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives.

Evry Health is the major medical division of Globe Life (NYSE: GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Position Overview

The Provider Dispute & Adjustment Specialist is responsible for the end-to-end management of provider dispute resolution and claim adjustment processing within a commercial health plan environment. This role serves as a subject matter expert for provider billing disputes, payment reconsiderations, ensuring that all cases are resolved accurately, fairly, and in compliance with applicable regulatory requirements and internal policies.

The Specialist conducts in-depth research into claim histories, contract terms, benefit language, and applicable state and federal regulations to determine appropriate outcomes. A critical component of this role is the ability to interpret complex provider requests, communicate clear and well-supported decisions in writing, and collaborate cross-functionally to identify and correct systemic claim adjudication issues.

This role plays a critical part in ensuring provider satisfaction, maintaining regulatory compliance, and driving continuous process improvement at Evry Health. This is a fully remote position; candidates must reside within the United States in the Eastern or Central time zone.