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Claims Resolution Manager Jobs in Pennsylvania (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 ... Regularly communicate with hospital staff and department management on any accounts receivable ...

Great American Insurance Group

$110K - $140K/yr

Claims Resolution Services is seeking a Claims Technical Director to focus primarily on handling a ... Manages a book of claims, including construction defect and property claims, involving significant ...

New

Penske

Manager - Liability Claims

Reading, PA

Position Summary: The Liability Claims Manager leads the day-to-day operations of Penske ... resolution of liability, property, cargo, brokerage, and subrogation claims across the entire ...

New

Penske

Manager - Liability Claims

Reading, PA · On-site

Position Summary: The Liability Claims Manager leads the day-to-day operations of Penske ... resolution of liability, property, cargo, brokerage, and subrogation claims across the entire ...

New

Penske

Manager - Liability Claims

Reading, PA

Position Summary: The Liability Claims Manager leads the day-to-day operations of Penske ... resolution of liability, property, cargo, brokerage, and subrogation claims across the entire ...

New

Cna

General Liability Claims Consultant

Wyomissing, PA · 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 ...

Cna

General Liability Claims Consultant

Radnor, PA · 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 ...

Hancock Claims Consultants

$32 - $40/hr

... claims management. At Hancock, we are at the forefront of claims resolution services, offering nationwide coverage, swift and comprehensive claims inspections, and unparalleled quality and precision.

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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 cities in Pennsylvania are hiring for Claims Resolution Manager jobs?

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

Claims Resolution Manager jobs near you

Claims Resolution Specialist

Camp Hill, PA

Select Medical
See more jobs at Select Medicalexternal

$18.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 hours ago

Job description

OverviewClaims 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 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 our patients are not impacted.

We offer an exceptional employee experience, full-time hours, full benefits, paid training, and advancement opportunities. Our team offers flexible, first shift, Monday through Friday schedules. This would include two fifteen-minute breaks and one half-hour lunch. We allow for casual work attire; jeans are our norm!

Responsibilities
  • Investigate and follow-up on all open balances for accounts that have received a payment or denial, or that are greater than 30 days from billing. Contact responsible party to establish reason for non-payment document in system all verbal and written communication relative to open account balance, and institute timely follow-up with responsible party as a result of last contact to assure progress in resolving account with payment.
  • Maintain consistent, productive, and timely follow-up, as often as is needed to collect on the account. Time between account follow up is not to exceed 30 days.
  • Maintain a productivity of 20 to 25 accounts per day. This is subject to change based on volume changes and operational needs.
  • Make outgoing calls to patients, insurance companies and attorneys regarding claim status in order to reduce both outstanding receivables.
  • Regularly communicate with hospital staff and department management on any accounts receivable issues/problematic payor trends.
  • Identify and resolve issues impacting the timely collection of open receivables.
  • As necessary, request account adjustments as identified via write off requests and refund requests.
  • Notify database operations of changes or additions to specific payor, plan, contract, address, or other pertinent information as necessary.
  • Meet the expectations and goals for productivity and collections targets as set forth by management.
  • Performs other duties or special projects as assigned.
Qualifications

Required:

  • High School Diploma or Equivalent
  • One year of experience  within a medical billing, medical collecting or claims processing role.
  • Private and commercial claims collection experience (ideally provider side)
  • Medicare and Medicaid

Preferred:

  • Computer Skills
  • Microsoft Office:
  • Outlook
  • Excel
  • Ability to work with multiple programs simultaneously.
  • Good interpersonal, oral and written communication skills.
  • Previous experience in metrics based role, where production/quality standards are upheld.
  • Time management and organizational skills
  • Proven experience with investigative research.
  • Ability to work independently and as part of team to reach mutually established goals.
  • Attention to detail
  • Flexibility and being open to change
  • This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Additional Data

Select Medical strives to provide our employees with a solid work-life balance, as we understand that happy employees have both fulfilling careers and fulfilling lives beyond our doors.

  • An extensive and thorough paid orientation program.
  • Paid Time Off (PTO) and Extended Illness Days (EID).
  • Health, Dental, and Vision Insurance; Life insurance; Prescription coverage.
  • A 401(k) retirement plan with company match.
  • No Required Weekends

Working Conditions/Physical Demands:

  • Office Environment
  • Sitting for extended periods of time
  • Ability to lift weight up to 35 lbs. 

Equal Opportunity Employer/including Disabled/Veterans

Employment Type: OTHER

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