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Claims Resolution Manager Jobs in Florida (NOW HIRING)

Gallagher

Senior Resolution Manager

Tallahassee, FL · Remote

Whether you're managing claims, supporting clients, or improving processes, you'll play a vital ... resolution. * Provide exceptional customer service to our claimants on behalf of our clients ...

Gallagher

Senior Resolution Manager

Orlando, FL · Remote

Whether you're managing claims, supporting clients, or improving processes, you'll play a vital ... resolution. * Provide exceptional customer service to our claimants on behalf of our clients ...

Cna

General Liability Claims Manager

Lake Mary, FL · Hybrid

Under general direction manages a team of claims professionals for our General Liability line of ... Responsibilities include overseeing all claim resolution activities of the team to ensure accurate ...

UF Health

Insurance Claims Specialist

Gainesville, FL · On-site

... resolution, compliance, and customer service excellence. ???? Work Style: Onsite ???? Location Requirement: Gainesville, FL ???? FTE: Full-Time (1.0 FTE) Manages and evaluates insurance claims to ...

UF Health

Insurance Claims Specialist

Gainesville, FL · On-site

... resolution, compliance, and customer service excellence. Work Style: Onsite Location Requirement: Gainesville, FL FTE: Full-Time (1.0 FTE) Manages and evaluates insurance claims to ensure accurate ...

ARC Group

Claims Adjustor (BI)

Oakland Park, FL · Remote

... efficient claims resolution. Documentation and Reporting: * Prepare detailed and accurate ... Provide regular reports to management on claim status, legal developments, and financial ...

Cna

General Liability Claims Consultant

Lake Mary, FL · Hybrid

$72K - $141K/yr

Makes recommendations on claims processes and resolution strategies to management. * Analyzes claims activities; prepares and presents reports to management and other internal business partners and ...

USAA

Claims Auto Adjuster

Tampa, FL · Hybrid

$46K - $61K/yr

One or more years of auto liability claims experience managing claims from initial contact through resolution. * Minimum one year of experience managing a pending inventory with demonstrated ...

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All JobsClaims Resolution JobsClaims Resolution Manager JobsClaims Resolution Manager Jobs in Florida

Claims Resolution Manager information

What does a claims resolution manager do?

A Claims Resolution Manager oversees the process of handling insurance claims from initiation to closure, ensuring that claims are resolved efficiently and fairly. They investigate claim details, coordinate with adjusters, clients, and third parties, and work to resolve disputes or issues that may arise during the claims process. Their goal is to ensure compliance with company policies and legal regulations while optimizing customer satisfaction and minimizing losses for the organization.

What are the primary challenges a claims resolution manager faces when balancing client expectations with policy limitations?

Claims Resolution Managers often navigate the delicate balance between meeting client expectations and adhering to insurance policy terms. One common challenge is communicating complex policy details to clients who may be experiencing stress or frustration. Additionally, managers must ensure timely and fair claims processing while coordinating with adjusters, legal teams, and external vendors. Success in this role requires strong negotiation skills, empathy, and a thorough understanding of regulatory and company guidelines.

What are the key skills and qualifications needed to thrive as a claims resolution manager, and why are they important?

To thrive as a Claims Resolution Manager, you need a solid background in insurance claims processing, dispute resolution, and regulatory compliance, often supported by a bachelor's degree in business, finance, or a related field. Familiarity with claims management software, CRM tools, and relevant certifications such as AIC or CPCU is common. Strong analytical thinking, negotiation skills, and effective communication are crucial soft skills for managing complex cases and guiding teams. These abilities ensure efficient claims handling, customer satisfaction, and minimized financial risk for the organization.

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

AspectClaims Resolution ManagerClaims Adjuster
CredentialsInsurance licenses, sometimes management certificationsInsurance licenses, specific to claims handling
Work EnvironmentSupervisory roles, team coordinationField or office-based, claims investigation
Employer & Industry UsageInsurance companies, claims departmentsInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding managerial roles in claimsDetails about claims handling and investigation

The Claims Resolution Manager oversees claims processes and manages teams, focusing on strategy and resolution. Claims Adjusters handle the investigation and evaluation of individual claims. While both roles require insurance licenses, the manager's role is more supervisory, whereas the adjuster is more hands-on with claims investigation.

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

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

What cities in Florida are hiring for Claims Resolution Manager jobs?

Cities in Florida with the most Claims Resolution Manager job openings:

Claims Resolution Manager jobs near you

Denials Management and Claims Resolution

Gastromed, LLC

Coral Gables, FL • On-site

$17.25 - $23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 28 days ago

Job description

JOB TITLE: Denials Management & Claims Resolution Specialist 

REPORTS TO: Revenue Cycle Manager 

FLSA STATUS: Non-Exempt  

JOB SUMMARY: 

The Denials Management & Claims Resolution Specialist is responsible for identifying, investigating, appealing, and resolving denied or rejected insurance claims to maximize reimbursement and reduce accounts receivable. This position works closely with providers, coding, billing, and payer representatives to resolve claim issues, identify denial trends, and improve revenue cycle performance. The specialist ensures compliance with payer guidelines while supporting timely and accurate reimbursement.

QUALIFICATIONS/EDUCATION:

 

  • High School Diploma required.
  • Minimum of two (2) years of experience in medical billing, collections, denial management, or claims resolution.
  • Experience with insurance appeals, denial management, and payer follow-up required.
  • Knowledge of Medicare, Medicaid, and commercial insurance billing guidelines.
  • Bilingual English/Spanish preferred; must be able to read, write, and speak English.
  • Basic computer knowledge including Microsoft Word, Excel, Electronic Health Records (EHR), billing software, payer portals, email, and e-fax systems.

 

CERTIFICATIONS/LICENSES:

  • CPC preferred 

 

ABILITIES/SKILLS:

  • In-depth knowledge of CPT, ICD-10, HCPCS, CMS-1500 claim forms, medical terminology, and payer billing requirements.
  • Strong understanding of denial management, claims resolution, reimbursement methodologies, and insurance appeals.
  • Knowledge of Medicare, Medicaid, and commercial payer policies.
  • Excellent analytical and problem-solving skills.
  • Strong organizational skills with the ability to prioritize multiple accounts and meet appeal deadlines.
  • Excellent written and verbal communication skills.
  • Ability to work independently with minimal supervision.
  • Ability to maintain patient confidentiality and comply with HIPAA regulations.
  • Demonstrates proficiency in Electronic Health Records (EHR), billing software, Microsoft Office, and payer portals.
  • Must be dependable, detail-oriented, and able to follow company policies and procedures.

 

SUPERVISORY RESPONSIBILITIES: 

N/A 

 

ESSENTIAL DUTIES/ RESPONSIBILITIES: 

  • Investigate, analyze, and resolve denied, rejected, and underpaid insurance claims. 
  • Prepare, submit, and track first-level and subsequent insurance appeals within payer deadlines. 
  • Review medical records, coding, documentation, and billing information to determine the cause of claim denials. 
  • Identify denial trends and recommend corrective actions to reduce future denials and improve reimbursement. 
  • Communicate with insurance companies to resolve claim payment issues and obtain claim status updates. 
  • Work collaboratively with providers, coders, billers, and authorization staff to resolve documentation, coding, and billing deficiencies. 
  • Request claim adjustments, corrected claims, or reconsiderations as appropriate to resolve outstanding balances. 
  • Monitor accounts receivable and prioritize denied claims based on aging and financial impact. 
  • Maintain accurate and detailed account notes and documentation within the billing system. 
  • Ensure all denial and appeal activities comply with payer guidelines and regulatory requirements. 
  • Prepare denial management and appeals activity reports for the Revenue Cycle Manager. 
  • Assist with identifying process improvements to enhance claim acceptance rates and reduce reimbursement delays. 
  • Perform other duties as assigned by management.
Pre-Employment Requirements
  • Successful completion of a criminal background check.
  • Successful completion of professional reference checks.
Benefits

We offer a competitive salary and a comprehensive benefits package, including:

  • 100% employer-paid employee health insurance
  • Dental Insurance
  • Vision Insurance
  • Life Insurance
  • 401(k) Retirement Plan
  • Paid Time Off (PTO)
  • Paid Holidays