Independent Dispute Resolution Specialist

Independent Dispute Resolution (IDR) Specialist Wellfleet, a Berkshire Hathaway company, delivers customer-centric accident and health insurance, with quality service and uncompromising ethics. Wellfleet works to protect people against risk throughout every stage of life from grade school to college to the workplace. Founded in 1993 as Consolidated Health Plans (CHP), Wellfleet, headquartered in Springfield, Mass., is one of the nation's leading providers of health and accident insurance products to the higher education market. Wellfleet, a Berkshire Hathaway Company, seeks an experienced Independent Dispute Resolution (IDR) Specialist to support the Wellfleet Student Health team. The Independent Dispute Resolution Specialist (IDR) is responsible for overseeing the Federal Independent Dispute Resolution (No Surprise Act) claim dispute process to ensure quality and timely handling of disputes. Must possess good communication skills, be detail oriented problem solver with good analytical and time management skills. In this role, you will Be able to navigate the company claim system and process adjustments Be able to interpret policy language Maintain a working knowledge of State/Federal insurance regulations and mandates Maintain understanding of the products serviced by Wellfleet Maintain knowledge of company systems Respond to email inquiries from vendors and IDR entities professionally, accurately, and promptly Maintain comprehension in interpreting documents, such as training manuals, correspondence, brochures, policies etc. Manage Independent Dispute Resolution (IDR) inquiries by ensuring applicability and timely and accurate payment of IDR entity fees Maintain IDR files to support determinations, ensuring eligibility based on federal regulations, and meeting strict deadlines Process IDR determination adjustments in accordance with plan benefits Work with vendors associated with IDR process as well as Wellfleet legal team to identify areas of process improvement Prepare supporting documentation to appeal non-eligible IDR disputes Assist with printing and correlating vendor appeals ensuring timely entry into claims system Assist with processing vendor fees Ability to multitask and adhere to deadlines and handle special projects Follow company and department workflows as approved by management Communicate issues, concerns etc. to supervisor in a timely manner Perform other duties as assigned We are looking for candidates with High school diploma with 3+ years' work experience in the insurance field, preferably working in a health insurance setting or Professional Certification in Billing and Coding Experience with the Federal IDR process is preferred Experience in medical billing or claims handling Understanding of medical billing and codes Demonstrated ability to efficiently manage multiple assignments, prioritize tasks and adapt to changes in a fast-paced environment to meet deadlines Possess effective communication skills and be patient, resilient and stress tolerant Responsible and dependable with focus on attention to detail Excellent phone etiquette skills Strong proficiency with Microsoft suite products including advanced MS Excel Why Wellfleet? Here at Wellfleet, we foster a culture of growth that enables engaged and high-performing professionals to be empowered to deliver our mission and vision. Our employees are a team devoted to providing customer service that exceeds expectations of our members and clients. Successful team members continually look for ways to improve product delivery and value. Wellfleet offers a competitive compensation package and comprehensive benefits package including life, health and dental, vision, 401K retirement plan, short- and long-term disability coverage, flexible/dependent care spending account, tuition reimbursement, and business casual dress. General: Wellfleet is part of the MedPro Group family. As such, all Wellfleet team members are employees of MedPro Group Inc. We are an Equal Opportunity Employer. The base hourly range is $26 to $31. This range anticipates the low and high end of the wages for this position. Actual salaries will vary and are based on factors such as a candidate's qualifications, skills and competencies. Salary is one component of Wellfleet's total compensation and benefits package, which includes medical, vision and dental insurance options, life and accident insurance, 401(k), and short-term and long-term disability insurance. For a more detailed overview, visit our careers website at: wellfleetinsurance.com/about/careers.

Created: 2026-03-04