ZipRecruiter

Log In

1

Claims Resolution Jobs (NOW HIRING)

Caduceus Inc

Claims Resolution Specialist

Jersey City, NJ · On-site

$21 - $23/hr

Perform claims resolution or medical billing and appeals or claims denials in Athena within the last two years. * Conduct AR Follow-up both on front end scrubs and back end denials through best ...

Select Medical

Claims Resolution Specialist

Camp Hill, PA · On-site

$18.50/hr

If so, our Claims Resolution Specialist position may be a phenomenal career for you within Select Medical! Our dynamic team has the responsibility of resolving outstanding insurance claims so that ...

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 ...

next page

Showing results 1-20

All JobsClaims Resolution Jobs

Claims Resolution information

See salary details

$34K

$72.1K

$118.5K

How much do claims resolution jobs pay per year?

As of Aug 8, 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 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.

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.

Is claims resolution processing a stressful job?

Claims resolution processing can be stressful due to tight deadlines, high workload, and the need for accuracy in evaluating claims. It often requires strong attention to detail, communication skills, and the ability to handle difficult situations with claimants. Managing stress levels may involve organizational skills and support from team resources.

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.
More about Claims Resolution jobs
What are the most commonly searched types of Claims Resolution jobs? The most popular types of Claims Resolution jobs are:
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? The top searched job categories for Claims Resolution jobs are:
Claims Resolution jobs near you

Claims Resolution Specialist

Integrated Pain Management Medical Group, Inc.

Walnut Creek, CA • On-site

$28 - $35/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 16 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.
  • Collaborate with coding and clinical teams to obtain information needed for claim resolution.
  • Assist with reducing claim holds and billing delays.

Audit & Compliance Support

  • Participate in routine claim quality reviews and internal audit activities.
  • Ensure claim corrections comply with payer regulations, organizational policies, and billing guidelines.
  • Support Revenue Integrity initiatives through accurate claim review and documentation.
  • Maintain knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial payer requirements.
  • Adhere to HIPAA, CMS, and organizational compliance standards.

Documentation & Reporting

  • Maintain detailed documentation of claim investigations, resolutions, payer communications, and follow-up activities.
  • Track assigned workloads and resolution outcomes.
  • Assist with compiling information for denial trend reporting and operational reviews.
  • Provide feedback regarding workflow issues contributing to claim errors or payment delays.
  • Assumes other responsibilities as appropriate to the position and organizational needs



Qualifications:

  • High School Diploma or equivalent required.
  • Associate degree in Healthcare Administration, Medical Billing and Coding, or related field preferred.
  • Minimum 2-4 years of experience in medical billing, claims resolution, denial management, accounts receivable, or healthcare revenue cycle operations.
  • Working knowledge of Medicare, Medicaid, Workers' Compensation, and Commercial insurance billing requirements.
  • Knowledge of CPT, ICD-10-CM, HCPCS, modifiers, and medical terminology.
  • Experience researching and resolving denied or rejected claims.
  • Strong analytical and critical thinking skills.
  • Ability to manage multiple priorities and meet productivity expectations.


Compensation Range: 

$28.00 to $35.00 Hourly

All compensation ranges are posted based on internal equity, job requirements, experience, and geographical locations.


Why You'll Love Working Here:

  • Amazing work/life balance
  • Generous Medical, Dental, Vision, and Prescription benefits (PPO & HMO)
  • 401(K) Plan with Employer Matching
  • License & Tuition Reimbursements
  • Paid Time Off
  • Holiday Pay & Floating Holiday
  • Employee Perks and Discount Programs
  • Supportive environment to help you grow and succeed

Boomerang Healthcare (BHC) is a multidisciplinary and comprehensive team of experienced, committed healthcare providers that treat pain. Our team of doctors approaches each patient with one goal in mind: to help patients return to normal daily activities. We work with our patients to identify the cause of their pain and create a personalized treatment plan, recognizing that no two patients are alike, and neither is their pain. Our providers create a comprehensive care plan, then monitor, manage and coordinate patient access to health services at BHC. 

Boomerang Healthcare strives to be a diverse workforce that reflects, at all job levels, the patients we serve. We are an equal opportunity employer. Boomerang Healthcare is committed to compliance with the American Disabilities Act. If you require reasonable accommodation during the application process or have a question regarding an essential job function, please contact us.



Monday-Friday, 8am-5pm
40