Provider Dispute & NSA Adjuster

This role requires deep expertise in open negotiation and IDR processes, serving as a subject matter expert and key resource for complex out-of-network dispute resolution. You’ll also identify trends in disputes and partner closely with Claims, Customer Service, and Compliance to improve workflows, reduce errors, and strengthen the overall claims process.

This role plays a critical role in ensuring accurate, compliant, and timely resolution of provider disputes while driving continuous process improvement at Evry Health. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone.

About Evry Health and Globe Life

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.

This role requires deep expertise in open negotiation and IDR processes, serving as a subject matter expert and key resource for complex out-of-network dispute resolution. You’ll also identify trends in disputes and partner closely with Claims, Customer Service, and Compliance to improve workflows, reduce errors, and strengthen the overall claims process.

This role plays a critical role in ensuring accurate, compliant, and timely resolution of provider disputes while driving continuous process improvement at Evry Health. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone.

About Evry Health and Globe Life

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.

•  Minimum 3–5 years of experience in a commercial health plan environment, including claim adjudication, provider disputes/appeals, and open negotiation and/or Federal IDR case management under the No Surprises Act


• Strong experience with Texas open negotiation (Chapter 1467) and working knowledge of Texas Department of Insurance (TDI) requirements, including timelines, filing requirements, and IDR processes.


• Understanding of Texas vs. federal dispute frameworks, including when to apply state regulated (fully insured) vs. ERISA (self-funded) guidelines


• Strong working knowledge of CPT, HCPCS, ICD-10, and revenue codes, as well as QPA and NSA-related regulatory requirements


• Ability to analyze complex claim scenarios and apply contract, coding, and policy language to dispute decisions


• Strong written communication skills, including experience drafting clear and professional provider responses


• Proficiency in claims processing systems and dispute/appeals management platforms and basic data analysis (Excel or similar tools)

• Associate or Bachelor's degree in Healthcare Administration, Business, or a related field (or equivalent experience)


• Professional certification such as Certified Professional Coder (CPC), Certified Professional Biller (CPB), or similar


• Experience with FAIR Health, Cotiviti, or similar benchmarking tools used in QPA or payment dispute contexts


• Prior experience developing call center training materials or conducting staff training


• Knowledge of additional state-specific prompt pay requirements beyond Texas