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Case Resolution Specialist Jobs (NOW HIRING)

County of Tehama

Case Resource Specialist I/II

Red Bluff, CA · On-site

$22.07 - $26.83/hr

SALARY (A-E Steps) Case Resource Specialist I: $22.07 - $26.83 Hourly / $1,765.60 - $2,146.40 Biweekly Case Resource Specialist II: $24.37 - $29.62 Hourly / $1,949.60 - $2,369.60 Biweekly Bilingual ...

D.LAW INC

Case Review Specialist

Pasadena, CA · On-site

$30/hr

Description CAREER OPPORTUNITY CASE REVIEW SPECIALIST *We are not currently hiring for this role, but are accepting applications to join our waitlist.* A reputable, fast-growing law firm practicing ...

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Case Resolution Specialist information

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How much do case resolution specialist jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for case resolution specialist in the United States is $20.76, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $23.32 per hour, depending on experience, location, and employer.

What is the difference between Case Resolution Specialist vs Claims Adjuster?

AspectCase Resolution SpecialistClaims Adjuster
Required CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; licensing or certification often required
Work EnvironmentCustomer service centers, insurance companiesInsurance companies, field work, offices
Employer & Industry UsageInsurance, healthcare, legal sectorsInsurance industry primarily
Common Search & Comparison IntentUnderstanding job roles, responsibilities, and qualificationsComparing claims processing and settlement roles

The main difference is that a Case Resolution Specialist focuses on resolving customer cases, often involving communication and problem-solving, while a Claims Adjuster primarily evaluates insurance claims, investigates damages, and determines payouts. Both roles require strong communication skills and knowledge of insurance processes, but their daily tasks and focus areas differ.

What is a Case Resolution Specialist?

A Case Resolution Specialist is a professional responsible for managing and resolving customer or client cases, complaints, or disputes within an organization. They investigate issues, communicate with relevant parties, and work to find timely and satisfactory solutions. Case Resolution Specialists often document case details, follow company policies, and may suggest process improvements to prevent future issues. Their goal is to ensure customer satisfaction while maintaining compliance with regulations and company standards.

How does a Case Resolution Specialist typically collaborate with other departments to resolve client issues?

As a Case Resolution Specialist, you will often work closely with teams such as customer service, technical support, legal, and operations to gather information and coordinate solutions for complex client cases. Effective communication and a collaborative approach are essential, as you may need to facilitate meetings, share case updates, and ensure all stakeholders are aligned on resolution steps. This cross-functional teamwork not only speeds up case resolution but also helps in identifying process improvements for future cases.

What are the key skills and qualifications needed to thrive as a Case Resolution Specialist, and why are they important?

To thrive as a Case Resolution Specialist, you need strong problem-solving abilities, attention to detail, and a background in dispute resolution or customer service, often supported by a relevant degree or equivalent experience. Familiarity with CRM systems, case management software, and documentation tools is typically required. Excellent communication, patience, and negotiation skills help build rapport and facilitate effective conflict resolution. These competencies are crucial for efficiently resolving cases, maintaining customer satisfaction, and upholding organizational standards.
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What states have the most Case Resolution Specialist jobs? States with the most job openings for Case Resolution Specialist jobs include:
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Case Resolution Specialist jobs near you
Infographic showing various Case Resolution Specialist job openings in the United States as of June 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 1% Temporary, and 2% Contract. Highlights an 80% Physical, 2% Hybrid, and 18% Remote job distribution, with an average salary of $43,188 per year, or $20.8 per hour.
Medi-Cal Eligibility Resolution Specialist - LA & OC

Medi-Cal Eligibility Resolution Specialist - LA & OC

Libertana Home Health

Remote

$27 - $30/hr

Other

Posted 7 days ago

Key responsibilities

  • Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows.

  • Oversee and coordinate Medi-Cal redetermination submissions, including tracking cycles and engaging members.

  • Communicate with county eligibility workers and conduct in-person visits to county offices when necessary to resolve pending or denied actions.

Job description

Medi-Cal Eligibility Resolution Specialist

Position: Medi-Cal Eligibility Resolution Specialist

Pay Range: $27.00-$30.00 PER HR

Reporting To: Lead Medi-Cal Eligibility Resolution Specialist

Work Type: Remote

POSITION SUMMARY:

The Medi-Cal Eligibility Resolution Specialist is responsible for identifying, resolving, and preventing Medi-Cal eligibility issues that impact member access to services or hinder reimbursement. This role ensures timely coordination of Medi-Cal redeterminations, collaborates with county eligibility offices, and supports members through complex eligibility processes. The position is primarily remote, with required field visits to county Medi-Cal offices when in-person resolution is more effective. Specialists are assigned to specific counties or regions to build strong local relationships and expedite issue resolution.

QUALIFICATIONS:

  1. Strong knowledge of Medi-Cal eligibility and public benefit programs
  2. Knowledge of Medi-Cal eligibility rules and redetermination processes.
  3. Experience in working with electronic healthcare systems, and state eligibility systems.
  4. Familiar with Microsoft Word and Excel programs.
  5. Strong analytical, organizational and communication skills.
  6. Strong communication skills.
  7. Experience in a health plan, county eligibility office or healthcare revenue cycle.
  8. Bilingual in Spanish preferred.
  9. Experience resolving insurance denials or appeals.
  10. Preferably, has a bachelor's degree in healthcare, business administration or related field.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The following is a representation of the major duties and responsibilities of this position. The agency will make reasonable accommodations to allow otherwise qualified applicants with disabilities to perform essential functions.

  1. Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows.
  2. Conduct eligibility verification using state systems, EMR platforms, and insurance databases.
  3. Communicate with county eligibility workers to clarify case status and resolve pending or denied actions.
  4. Oversee and coordinate Medi-Cal redetermination submissions.
  5. Track redetermination cycles and proactively engage members.
  6. Contact members to gather required information and explain eligibility requirements.
  7. Build relationships with county Medi-Cal offices.
  8. Collaborate with internal departments including Member Services, Revenue Cycle, Clinical Teams, and Compliance.
  9. Maintain accurate, audit-ready documentation.
  10. Conduct in-person visits to county offices when necessary.
  11. Track and report eligibility trends and case outcomes.
  12. Driving will be required to county offices.
  13. Maintain confidentiality, HIPAA compliance, and knowledge of mandated reporting requirements.
  14. Uphold agency standards, policies, and procedures as outlined in the Employee Handbook.
  15. Participate in departmental meetings and trainings as required.
  16. Performs other duties as assigned.

PHYSICAL REQUIREMENTS:

  • Stand, sit, talk, hear, and use of hands and fingers to operate computer, telephone, and keyboard on a frequent basis up to 40% of the time.
  • Reach, stoop, kneel and bend up to 20% of the time
  • Moderate amount of walking up to 15% of the time.
  • Moderate amount of driving up to 25% of the time.
  • Close vision requirements due to computer work on a frequent basis
  • Light to moderate lifting may be required up to 25lbs on a frequent basis.
  • Pushing and pulling up to 25lbs.

Apply