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Claims Resolution Specialist Jobs (NOW HIRING)

Caduceus Inc

Claims Resolution Specialist

Jersey City, NJ · On-site

$21 - $23/hr

Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S. * Perform claims resolution or medical billing and appeals ...

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 ...

Select Medical

Claims Resolution Specialist

Camp Hill, PA · On-site

$18.50/hr

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 Claims ...

LHH US

Claims Resolution Specialist

Cincinnati, OH

$19 - $23/hr

Claims Resolution Specialist Cincinnati, Ohio Contract-to-hire Pay: $19 to $23 LHH Recruitment Solutions is partnering with our client to hire a Claims Resolution Specialist for a contract-to-hire ...

LHH US

Claims Resolution Specialist

Cincinnati, OH · On-site

$19 - $23/hr

Claims Resolution Specialist Cincinnati, Ohio Contract-to-hire Pay: $19 to $23 LHH Recruitment Solutions is partnering with our client to hire a Claims Resolution Specialist for a contract-to-hire ...

Claritev

Claims Resolution Specialist

Manhattan, NY · On-site +1

$20.23/hr

Claims Resolution Specialist At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our ...

UHS

Claims Resolution Specialist

Reno, NV

The Claims Resolution Specialist is a pivotal role in ensuring the efficient and accurate processing of healthcare claims. Primary responsibilities will be to analyze and resolve complex claims ...

UHS

Claims Resolution Specialist

Reno, NV · On-site

$18 - $27/hr

The Claims Resolution Specialist is a pivotal role in ensuring the efficient and accurate processing of healthcare claims. Primary responsibilities will be to analyze and resolve complex claims ...

VieMed

Claims Resolution Specialist

Lafayette, LA · On-site

Claims generation * Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit.

VieMed

Claims Resolution Specialist

Lafayette, LA · On-site

$14 - $18.50/hr

Claims generation * Establishes and maintains effective communication and good working relationships with insurance carriers, patients/family, and other internal teams for the patient's benefit.

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Claims Resolution Specialist information

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$12

$23

$43

How much do claims resolution specialist jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for claims resolution specialist in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Resolution Specialist, and why are they important?

To excel 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 industry certification. Familiarity with claims management software, customer relationship management (CRM) systems, and regulatory compliance tools is standard in this role. Outstanding communication, negotiation, and problem-solving skills help you resolve disputes efficiently and maintain positive client relationships. These competencies are crucial for ensuring timely, accurate claims processing and upholding customer satisfaction and regulatory standards.

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

AspectClaims Resolution SpecialistClaims Adjuster
CredentialsTypically requires insurance-related certifications or licensesRequires similar licenses and certifications, often the same as Claims Resolution Specialist
Work EnvironmentOffice settings, customer service interactions, claims processingFieldwork and office work, investigating claims on-site or remotely
Employer & IndustryInsurance companies, third-party administratorsInsurance companies, third-party administrators
Primary FocusResolving claims, customer communication, ensuring policy complianceInvestigating, evaluating, and settling claims

Both roles involve working within the insurance industry and require similar certifications. While Claims Resolution Specialists focus on customer communication and resolving claims efficiently, Claims Adjusters often handle the investigation and evaluation process, sometimes in the field. Understanding these differences can help job seekers identify the right position based on their skills and career goals.

What are some common challenges faced by Claims Resolution Specialists and how are they typically addressed?

Claims Resolution Specialists often encounter challenges such as managing a high volume of complex cases, communicating with dissatisfied clients, and navigating intricate insurance policies. To address these, specialists rely on strong organizational skills, effective communication, and a thorough understanding of industry regulations. Many employers also provide ongoing training and access to digital tools to help streamline the claims process and support collaboration with adjusters and other departments.

What does a Claims Resolution Specialist do?

A Claims Resolution Specialist is responsible for reviewing, investigating, and resolving insurance claims to ensure they are processed accurately and efficiently. They communicate with policyholders, providers, and other stakeholders to gather necessary information, analyze documentation, and determine the validity of claims. Their main goal is to resolve disputes or discrepancies in claims, making sure that payments are made correctly and in accordance with company policies and regulations.
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Claims Resolution Specialist jobs near you
Claims Resolution Specialist

Claims Resolution Specialist

Caduceus Inc

Jersey City, NJ • On-site

$21 - $23/hr

Full-time

Posted 15 days ago

Job description

Overview: Demonstrate competency as a claims resolution specialist for a large-scale multi-specialty/multi-site healthcare organizations in the U.S.


  • 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 practices. Scrub charges for submission and launch appeals via the Athena billing platform.
  • Review and clear claim edits in the system. Types of edits to be worked include registration, insurance, charge, and related issues for high volume practices.
  • Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).
  • Possess a thorough knowledge of appeals processing from end to end across all payer categories based on insurance denials.
  • Differentiate between best practices of appeal, coding review, credentialing review and/or adjustment.
  • Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
  • Candidate must be able to report and communicate issues and trends.
  • Meet or exceed daily productivity benchmarks.

Knowledge, Skill, and Experience Requirements:

  • 3+ years of experience in claims resolution or medical billing.
  • A minimum of 3 years of documented experience on the Athena billing platform is required.
  • Working knowledge of CPT, ICD-10, and medical terminology.
  • Complete understanding of follow-up processes.
  • Solid background in AR and overall Revenue Cycle policies and procedures.
  • Experience working in a physician billing environment.
  • Excellent communication skills.
  • Proficiency in Microsoft Office Suite, including Word and Excel.