Kforce has a client in Montebello, CA that is seeking a Claims Director of Provider Disputes. Summary: The Claims Director of Provider Disputes and Resolution has overall responsibility and accountability for all aspects of the claims operation for all Provider Disputes, provider projects, as well as provider refund recoveries. Within this role, the Director will ensure to meet regulatory compliance as well as company objectives as they relate to the resolution of the provider issue. The Director is responsible for leading and supporting each unit while being accountable for performance management, quality improvements and operational accuracy. The Director will leverage experience and integrate various components of cross-functional business decisions to continuously improve claims' processes and procedures. Responsibilities: * Participate in various forums, company initiatives, and other internal/external workgroups to support Claims integrity. Directs all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports * Oversees claim disputes from Providers as it relates to underpayment, overpayments, or no payment * Oversees provider projects as it relates to underpayments, overpayments, or no payment * Oversees refund recoveries, including requesting refunds as well as posting of the refunds to the related claim * Provides guidance to ensure that Claims Integrity efforts are performed with the highest and most current rules, regulation, policies, business rules and industry standards * Develops, manages, and sustains relationship with managed care service providers * Collaborates with various business unit's operational management in identifying, prioritizing, and resolving the issues impacting claims quality