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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 ...

ICBD

Claims Resolution Specialist

Fort Lauderdale, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

Claritev

Claims Resolution Specialist

Manhattan, NY · On-site

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 ...

ICBD

Claims Resolution Specialist

Pompano Beach, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Fort Lauderdale, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Hallandale, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Fort Lauderdale, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Hollywood, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Fort Lauderdale, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

Jorie AI

Claims Resolution Specialist

Oak Brook, IL · On-site

$26/hr

The Claims Resolution Specialist is responsible for managing Accounts Receivable and resolving clearinghouse rejections across multiple specialties and clients. This role requires deep end to end ...

Jorie AI

Claims Resolution Specialist

Oak Brook, IL · Remote

Salary: $26/hr The Claims Resolution Specialist is responsible for managing Accounts Receivable and resolving clearinghouse rejections across multiple specialties and clients. This role requires deep ...

ICBD

Claims Resolution Specialist

Lauderdale Lakes, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

ICBD

Claims Resolution Specialist

Lauderdale Lakes, FL · On-site

Claims Resolution Specialist - Behavioral Health - Exact Billing Solutions (EBS) Lauderdale Lakes, FL Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals ...

Jorie AI

Claims Resolution Specialist

Oak Brook, IL · On-site

The Claims Resolution Specialist is responsible for managing Accounts Receivable and resolving clearinghouse rejections across multiple specialties and clients. This role requires deep end to end ...

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How much do claims resolution specialist jobs pay per hour?

As of May 28, 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 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.

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.

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What states have the most Claims Resolution Specialist jobs? States with the most job openings for Claims Resolution Specialist jobs include:
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Claims Resolution Specialist jobs near you
Infographic showing various Claims Resolution Specialist job openings in the United States as of May 2026, with employment types broken down into 95% Full Time, 2% Part Time, and 3% Contract. Highlights an 80% Physical, 7% Hybrid, and 13% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

Claims Resolution Specialist

Innovative Hematology, Inc.

Indianapolis, IN • On-site, Remote

Other

Posted 28 days ago

Job description

About IHTC
At the Innovative Hematology (IHI), we offer a future where people with rare blood disorders flourish. Our experts provide the highest quality comprehensive services and holistic care to patients with bleeding, clotting and other hematologic disorders, and to their families.
What You Will Do
The Claims Resolution Specialist is a high-impact, project-based role designed to support the organization during a critical phase of revenue cycle transformation. This position offers the opportunity to contribute to enterprise-wide improvements in claims performance while demonstrating capability for potential long-term placement as organizational needs evolve.
This role is responsible for the end-to-end resolution of complex, high-dollar hemophilia-related insurance claims that have been denied, underpaid, or delayed by commercial, government, or specialty payers.
Serving as both an executional expert and a strategic contributor, the Claims Resolution Specialist leverages deep expertise in payer behavior, billing practices, and appeals strategy to drive claim resolution while identifying systemic trends and opportunities for upstream process improvement.
The ideal candidates will bring a strong analytical and problem-solving mindset, with the ability to operate effectively in an evolving environment. This individuals will play a key role in strengthening reimbursement outcomes, reducing denials, and informing the future-state design of revenue cycle operations.
The Opportunities
Level II
  • Investigate, analyze, and resolve complex, high-dollar claims that have been denied, underpaid, or delayed, ensuring timely and accurate reimbursement
  • Review and interpret payer denials to identify root causes (e.g., medical necessity, coding, authorization, coverage limitations, contractual discrepancies)
  • Prepare and submit comprehensive, payer-specific appeal packages, including clinical documentation, medical necessity justification, and supporting evidence
  • Interpret and apply payer policies, contracts, and regulatory requirements to support successful claim resolution and escalation strategies
  • Collaborate cross-functionally with billing, clinical teams, specialty pharmacy, and providers to gather documentation and resolve barriers to payment
  • Communicate effectively with payer representatives to advocate for reconsideration and drive resolution of complex claims
  • Maintain accurate and detailed documentation of claim activity, appeal status, and payer interactions within claims management systems
  • Monitor appeal timelines and ensure compliance with payer and regulatory requirements
  • Identify denial trends and recurring issues, providing insights and recommendations to improve first-pass claim accuracy and reduce future denials
  • Contribute to process improvement efforts by partnering with leadership and peers to enhance workflows, reduce rework, and strengthen revenue cycle performance
  • Ensure compliance with organizational policies, payer requirements, and applicable federal and state regulations

Level I
  • Retrieve, compile, and produce complete medical records and supporting documentation for denied insurance claims and formal appeals
  • Coordinate the collection of clinical notes, treatment records, laboratory results, authorizations, referrals, physician orders, and other required materials from internal systems, providers, and external partners
  • Ensure all documentation meets payer-specific requirements, formatting standards, and submission timelines
  • Verify documentation accuracy, completeness, and consistency prior to submission to Claims Resolution Specialists or upload to payer portals
  • Prepare and organize appeal packets according to established processes, including indexing, labeling, and secure transmission
  • Track documentation requests, outstanding items, and submission deadlines to support timely appeal filing
  • Maintain detailed records of documentation requests and submissions within claims management or document management systems
  • Communicate effectively with internal departments such as clinical teams, medical records, billing, and pharmacy to obtain required materials
  • Support audit readiness and compliance by adhering to HIPAA, data privacy policies, and organizational documentation standards

Requirements
  • High School Diploma or general education degree (GED)
  • 2 - 5 years of experience in medical billing, claims resolution, or revenue cycle operations, with a focus on complex or high-dollar claims
  • Strong analytical and problem-solving skills, with the ability to identify patterns and root causes
  • Working knowledge of payer guidelines, appeals processes, and reimbursement methodologies
  • Ability to navigate ambiguity and contribute in an evolving, fast-paced environment
  • Strong attention to detail and commitment to accuracy and compliance
  • Effective communication and collaboration skills across cross-functional teams

Benefits
IHI is a not-for-profit program based in Indianapolis and offers a competitive salary and benefit package.
IHI is the only federally designated comprehensive hemophilia program in Indiana, and serves the entire state through services available in Indianapolis and at outreach clinics.
IHI is a leader in hemophilia care, education and clinical research and has a dedicated on-site multidisciplinary staff to ensure availability of a wide range of required services.
IHI participates in national and international clinical research, including new infusion products and therapies, investigation of long-term outcomes, and the impact of associated conditions. The IHTC research program provides patients access to new therapies, and an opportunity to improve care. Our center has more than 70 clinical research projects involving bleeding disorders, sickle cell disease, thrombosis and more.
IHI is an Equal Opportunity Employer.

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