ZipRecruiter

Log In

1

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

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 ...

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.

Encova Insurance

Injury Resolution Specialist

$69K - $110K/yr

Encova Insurance has an immediate opening for an Injury Resolution Specialist. This role will be ... Claims may be assigned as first notice, requiring a complete investigation and handling of all ...

Encova Insurance

Injury Resolution Specialist

Columbus, OH · On-site

$69K - $110K/yr

Encova Insurance has an immediate opening for an Injury Resolution Specialist. This role will be ... Claims may be assigned as first notice, requiring a complete investigation and handling of all ...

Encova Insurance

Injury Resolution Specialist

Concord, NC · Remote

$69K - $110K/yr

Encova Insurance has an immediate opening for an Injury Resolution Specialist. This role will be ... Claims may be assigned as first notice, requiring a complete investigation and handling of all ...

next page

Showing results 1-20

All JobsClaims Resolution Specialist Jobs

Claims Resolution Specialist information

See salary details

$12

$23

$43

How much do claims resolution specialist jobs pay per hour?

As of Aug 10, 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.
More about Claims Resolution Specialist jobs
What cities are hiring for Claims Resolution Specialist jobs? Cities with the most Claims Resolution Specialist job openings:
What are the most commonly searched types of Claims Resolution Specialist jobs? The most popular types of Claims Resolution Specialist jobs are:
Who are the top companies hiring for Claims Resolution Specialist jobs? The top employers for Claims Resolution Specialist jobs are:
What states have the most Claims Resolution Specialist jobs? States with the most job openings for Claims Resolution Specialist jobs include:
What job categories do people searching Claims Resolution Specialist jobs look for? The top searched job categories for Claims Resolution Specialist jobs are:
Claims Resolution Specialist jobs near you
Infographic showing various Claims Resolution Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

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 18 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