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Claims Resolution Jobs (NOW HIRING)

Select Medical

Claims Resolution Specialist

Camp Hill, PA · On-site

$18.50/hr

Overview Claims Resolution Specialist (in-office - on-site role) Starting at $18.50/hr but flexible for experienced candidates Do you enjoy puzzles and research? Are you results-oriented? If so, our ...

MMC Group

Claims Resolution - Exclusive

Helena, MT · On-site

$17 - $19/hr

Join Our Claims Resolution Team! No Weekends | Flexible Schedule | $17 to $19 per Hour Are you detail oriented, organized, and looking for a rewarding career where your work truly makes a difference ...

PMMC

Claims Resolution Analyst

Charlotte, NC · On-site

Claims Resolution Analyst Reports To: Claims Resolution Supervisor Department: Operations, Recovery About The Team At PMMC, our mission is to continuously improve the financial performance of health ...

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TEKsystems

Claims Resolution Specialist

Pompano Beach, FL

$21.68 - $24.40/hr

... claims - Email correspondence with vendors and providers to verify data, obtain invoices, retrieve missing claims, and/or missing data - Record invoices for all procedures and associated billing ...

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Claims Resolution information

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$34K

$72.1K

$118.5K

How much do claims resolution jobs pay per year?

As of Aug 28, 2026, the average yearly pay for claims resolution in the United States is $72,103.00, according to ZipRecruiter salary data. Most workers in this role earn between $50,000.00 and $89,000.00 per year, depending on experience, location, and employer.

What is claims resolution?

Claims resolution is the process of reviewing, investigating, and settling insurance claims filed by policyholders or third parties. Professionals in claims resolution evaluate the details of each claim, determine coverage eligibility, negotiate settlements, and ensure that all parties receive a fair outcome according to the policy terms. The goal is to resolve claims efficiently, accurately, and in compliance with legal and regulatory standards, while minimizing disputes and maintaining customer satisfaction.

What are the key skills and qualifications needed to thrive as a claims resolution specialist?

To thrive as a Claims Resolution Specialist, you need strong analytical abilities, attention to detail, and a background in insurance or finance, often supported by a relevant degree or equivalent experience. Familiarity with claims management systems, customer relationship management (CRM) software, and sometimes industry certifications like AIC (Associate in Claims) is advantageous. Excellent communication, negotiation, and problem-solving skills help you resolve disputes efficiently and maintain positive client relationships. These skills are crucial for ensuring accurate claims processing, minimizing errors, and delivering high-quality customer service.

How does a claims resolution specialist typically collaborate with other departments to resolve complex claims?

Claims Resolution Specialists regularly work with teams such as customer service, underwriting, and legal to gather necessary information and ensure claims are processed accurately. Collaboration often involves reviewing documentation, clarifying policy details, and communicating updates to all stakeholders. This multidisciplinary approach helps resolve issues efficiently and ensures compliance with company standards and regulations. Effective communication and teamwork are key to successfully managing and closing complex claims.

What is the difference between Claims Resolution vs Claims Adjuster?

AspectClaims ResolutionClaims Adjuster
Required CredentialsHigh school diploma or equivalent; certifications varyHigh school diploma; licensing or certification often required
Work EnvironmentOffice settings, customer service interactionsField work and office settings, inspecting damages
Industry UsageInsurance companies, claims processingInsurance companies, claims assessment
Job FocusResolving claims, customer communicationEvaluating damages, determining claim validity

Claims Resolution professionals primarily focus on processing and resolving insurance claims through customer communication, often working in office settings. Claims Adjusters evaluate damages and determine claim validity, frequently conducting field inspections. While both roles are integral to insurance claims, Claims Resolution emphasizes customer interaction and claim processing, whereas Claims Adjusters focus on damage assessment and validation.

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What states have the most Claims Resolution jobs?

States with the most job openings for Claims Resolution jobs include:

What job categories do people searching Claims Resolution jobs look for?

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Claims Resolution jobs near you

Claims Resolution Specialist

Walnut Creek, CA • On-site

Integrated Pain Management Medical Group, Inc.
See more jobs at Integrated Pain Management Medical Group, Inc.external

$28 - $35/hr

Full-time

Re-posted 7 days ago

Job description

The Claims Resolution Specialist is responsible for the day-to-day investigation and resolution of claim rejections, denials, edits, and reimbursement issues across a multi-site, multi-specialty healthcare organization specializing in pain management, physical medicine, and functional rehabilitation services.

Working closely with the Pre-Billing, Accounts Receivable (A/R), Denials Management, Coding, and Revenue Integrity teams, this position performs detailed claim reviews, researches payer requirements, corrects claim errors, and facilitates timely claim resubmission and payment. The Claims Resolution Specialist serves as a key resource in resolving billing issues and ensuring claims are processed accurately and efficiently.


*This is a remote role. We are only hiring in the following states: AZ, CA, NM, NV, OR, TX and WA.


What you will do:

Claims Resolution & Follow-Up

  • Investigate and resolve claim rejections, denials, and payer edits identified before or after claim submission.
  • Review claim history, payer correspondence, medical records, authorizations, and supporting documentation to determine the cause of claim issues.
  • Correct billing, coding, demographic, authorization, and insurance-related claim errors as appropriate.
  • Process claim corrections, adjustments, resubmissions, and reconsideration requests in accordance with payer guidelines.
  • Perform payer research and communicate directly with insurance carriers to resolve claim processing issues.
  • Monitor assigned work queues and ensure timely resolution of outstanding claims.
  • Escalate complex reimbursement, coding, or compliance issues to senior team members.

Denial Management Support

  • Partner with A/R and Denials Management teams to resolve denied and underpaid claims.
  • Assist in preparing appeal documentation and supporting materials for denied claims.
  • Identify recurring denial patterns and communicate findings to the Senior Claims Resolution Coordinator.
  • Maintain accurate documentation of denial resolution activities and payer communications.
  • Support efforts to reduce preventable denials and improve reimbursement outcomes.

Pre-Billing & Revenue Cycle Collaboration

  • Work closely with the pre-billing team to identify and correct claim issues prior to submission.
  • Review claims for completeness and compliance with payer billing requirements.
  • Verify insurance information, authorizations, referrals, diagnosis coding, procedure coding, and modifier usage.

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