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Claims Resolution Coordinator Jobs in Arizona (NOW HIRING)

Professional Transit

Claims Coordinator

Tucson, AZ · On-site

$17.60 - $26.40/hr

This position coordinates the full lifecycle of insurance claims and works closely with internal ... Coordinate insurance claims from intake through investigation, documentation and resolution.

USAA

Inside Senior Property Claims Adjuster

Phoenix, AZ · On-site +1

Partner with vendors and internal business partners to facilitate moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and ...

USAA

Inside Senior Property Claims Adjuster

Phoenix, AZ · On-site +1

Partner with vendors and internal business partners to facilitate moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and ...

USAA

Inside Senior Property Claims Adjuster

Phoenix, AZ · On-site +1

Partner with vendors and internal business partners to facilitate moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and ...

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Claims Resolution Coordinator information

What does a claims resolution coordinator do?

A Claims Resolution Coordinator is responsible for reviewing, investigating, and resolving insurance or billing claims that have been denied, delayed, or are otherwise outstanding. They work closely with insurance companies, healthcare providers, and patients to gather necessary information and documentation, ensuring claims are processed correctly and efficiently. Their goal is to minimize claim denials and maximize reimbursement by identifying and addressing issues in the claims process. Effective communication, attention to detail, and a thorough understanding of insurance policies and billing procedures are essential in this role.

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

To thrive as a Claims Resolution Coordinator, you need strong analytical abilities, attention to detail, and knowledge of insurance or healthcare claims processes, often supported by a relevant associate’s or bachelor’s degree. Familiarity with claims management software, billing systems, and regulatory compliance tools is typically required. Excellent communication, problem-solving skills, and the ability to manage conflict set top performers apart in this role. These skills are crucial for ensuring timely and accurate claim resolution, reducing errors, and maintaining positive relationships with clients and stakeholders.

What are some common challenges faced by claims resolution coordinators when working with insurance providers and clients?

Claims Resolution Coordinators often encounter challenges such as navigating complex policy details, managing tight deadlines, and communicating effectively with both insurance providers and clients who may be frustrated or anxious about their claims. Coordinators must be adept at problem-solving and remain patient and empathetic while gathering documentation, clarifying coverage, and negotiating settlements. Collaboration with other departments, such as billing or legal, is common to help resolve discrepancies and ensure a smooth claims process.

What is the difference between Claims Resolution Coordinator vs Claims Adjuster?

AspectClaims Resolution CoordinatorClaims Adjuster
CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma; insurance licensing often required
Work EnvironmentOffice setting, team collaboration, customer service focusOffice or field work, investigating claims, interacting with claimants and providers
Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Primary ResponsibilitiesCoordinate claim resolution processes, communicate with claimants, ensure timely processingEvaluate damages, determine claim validity, authorize payments

The Claims Resolution Coordinator primarily focuses on coordinating and facilitating the claims process, ensuring smooth communication and resolution. In contrast, Claims Adjusters evaluate claims directly, investigate damages, and make payment decisions. Both roles are essential in the insurance industry but differ in their core functions and responsibilities.

Is claims processing a stressful job?

Claims resolution coordinators often handle complex cases and tight deadlines, which can contribute to workplace stress. The job requires strong organizational skills and attention to detail, and workload fluctuations may also impact stress levels. However, many find the role manageable with proper training and support systems in place.

What are the most commonly searched types of Claims Resolution jobs in Arizona?

The most popular types of Claims Resolution jobs in Arizona are:

What are popular job titles related to Claims Resolution Coordinator jobs in Arizona?

For Claims Resolution Coordinator jobs in Arizona, the most frequently searched job titles are:

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

The top searched job categories for Claims Resolution Coordinator jobs in Arizona are:

What cities in Arizona are hiring for Claims Resolution Coordinator jobs?

Cities in Arizona with the most Claims Resolution Coordinator job openings:

Claims Resolution Coordinator jobs near you
Infographic showing various Claims Resolution Coordinator job openings in Arizona as of August 2026, with employment types broken down into 1% As Needed, 87% Full Time, 8% Part Time, 2% Temporary, and 2% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution.

Pharmacy Claims Adjudication Specialist

Onco360

Scottsdale, AZ • On-site

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Scottsdale, AZ. This will be a Full-Time position.This is a remote hybrid opportunity, after onsite training period.
Shift time between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits - life; and short and long-term disability

Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documents and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.

Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

#Company Values: Teamwork, Respect, Integrity, Passion
#IH

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