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Live In Claims Resolution Specialist Jobs (NOW HIRING)

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Account Resolution Specialist

Dallas, TX · On-site

$14.25 - $19.75/hr

Account Resolution Specialist Location: Dallas - Hospital Additional Posting Details: Monday ... Review and resolve credit balances in a timely manner * Follow-up on all billed claims to ensure ...

Clayton Services

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Tax Resolution Specialist

Houston, TX · On-site

$21 - $25/hr

Clayton Services is searching for a Tax Resolution Specialist to join a thriving company in the Houston Galleria area. The Tax Resolution Specialist will manage client cases from intake through ...

LeafHome

Resolution Specialist

Hudson, OH · On-site

S. and Canada, with continued expansion Position Summary The Resolution Specialist is responsible ... in dispute resolution, claims management, litigation support, insurance, or customer escalations.

LeafHome

Resolution Specialist

Hudson, OH

S. and Canada, with continued expansion Position Summary The Resolution Specialist is responsible ... in dispute resolution, claims management, litigation support, insurance, or customer escalations.

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All JobsFinance and Insurance JobsInsurance JobsInsurance Claims Specialist JobsLive In Claims Resolution Specialist Jobs

Live In Claims Resolution Specialist information

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$43

How much do live in claims resolution specialist jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for live in 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 is the difference between Live In Claims Resolution Specialist vs Claims Adjuster?

AspectLive In Claims Resolution SpecialistClaims Adjuster
CredentialsRelevant insurance certifications, claims trainingInsurance licenses, certifications often required
Work EnvironmentOn-site, often in client homes or officesOffice-based or remote, fieldwork possible
Employer & IndustryInsurance companies, third-party administratorsInsurance carriers, independent agencies
Search & Comparison IntentSimilar roles handling claims, resolution processClaims processing, settlement, and adjustment

Both roles involve handling insurance claims, but Live In Claims Resolution Specialists typically work directly with clients on-site to resolve claims, while Claims Adjusters often work in offices or remotely to evaluate and settle claims. The roles share similar certifications and industry usage, but differ mainly in work environment and daily responsibilities.

What is a live in claims resolution specialist?

A live-in claims resolution specialist is a professional who works on-site to review, investigate, and resolve insurance claims promptly. They often handle complex cases, communicate directly with claimants, and may use specialized software to assess coverage and settlement options, typically working full-time in an office or client environment.

What cities are hiring for Live In Claims Resolution Specialist jobs?

Cities with the most Live In 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:

What states have the most Live In Claims Resolution Specialist jobs?

States with the most job openings for Live In Claims Resolution Specialist jobs include:

Live In Claims Resolution Specialist jobs near you

AR Resolution Specialist Lead

The Cardiac and Vascular Institute

Gainesville, FL • On-site

$17 - $21/hr

Full-time

Re-posted 7 days ago

Job description

AR Resolution Specialist Lead
Department: Revenue Cycle Operations
Reports To: Revenue Cycle Manager/Revenue Cycle Director
FLSA Status: Non-Exempt
Location: Onsite / Hybrid / Remote
Shift: Day
Hours of Work: M-F
Employment Type: Full Time
Position Summary
The A/R Resolution Specialist Lead is a senior-level role responsible for leading the resolution of complex insurance accounts receivable while supporting overall team performance and driving timely reimbursement outcomes. This position serves as a subject matter expert in claims follow-up, denial management, appeals, and payer escalation, ensuring that high-risk, aged, and high-dollar accounts are resolved efficiently and accurately.
This role requires a deep understanding of the full revenue cycle, including front-end processes (registration, eligibility, authorization), coding, billing, and payer adjudication. The Lead Specialist is responsible for identifying root causes of denials and payment delays, resolving escalated accounts, and translating account-level findings into actionable insights that improve workflows and reduce future revenue leakage.
In addition to hands-on account resolution, the Insurance A/R Resolution Specialist Lead plays a critical role in guiding and supporting A/R team members and external vendor partners. This includes providing direction on complex accounts, reinforcing documentation standards, auditing account activity for quality and accuracy, and ensuring adherence to payer guidelines and organizational policies.
The Lead Specialist partners closely with leadership to monitor and improve key performance indicators such as A/R aging, denial rates, appeal success rates, and payer turnaround times. This role also contributes to the development and execution of targeted action plans aimed at improving collections, preventing denials, and enhancing overall revenue cycle efficiency.
Success in this role requires strong analytical skills, attention to detail, and the ability to manage multiple priorities in a fast-paced environment. The ideal candidate is proactive, solution-oriented, and capable of leading through influence while driving measurable improvements in both individual and team performance.
Key Responsibilities
Appeal Management
  • Review and resolve complex denied claims requiring appeals, reconsiderations, or payer escalation
  • Prepare and submit detailed appeal packages with supporting documentation including medical records, coding validation, and authorization details
  • Track appeal status, follow up on submissions, and ensure timely resolution
  • Identify appeal trends and recommend process improvements
  • Escalate high-dollar or recurring denial issues to leadership with actionable recommendations

Account Resolution and Documentation
  • Review account history including claim status, remittance details, payer communications, and prior follow-up activity
  • Determine and execute appropriate resolution actions such as corrected claims, resubmissions, adjustments, or transfers
  • Ensure all account activity is documented clearly and accurately in accordance with organizational standards
  • Maintain detailed notes including actions taken, payer responses, and next steps
  • Support team members with complex account research and resolution guidance

Accounts Receivable Management
  • Monitor assigned A/R work queues and prioritize accounts based on aging, payer, dollar value, and timely filing limits
  • Perform timely follow-up on outstanding insurance balances to reduce aging and improve cash collections
  • Track and analyze key A/R metrics including aging, denial rates, and payer turnaround times
  • Conduct audits of accounts including vendor-managed work to ensure quality and compliance
  • Identify barriers to reimbursement and escalate system, payer, or workflow issues

Denial Resolution
  • Analyze claim denials and rejections to determine root causes across the revenue cycle
  • Initiate appropriate resolution actions including corrected claims, reprocessing, reconsiderations, and appeals
  • Identify denial trends related to front-end, coding, billing, or payer processes
  • Collaborate with internal teams and vendors to resolve recurring denial issues
  • Assist in developing strategies to reduce denials and improve first-pass resolution rates

Leadership and Team Support
  • Serve as a subject matter expert and provide guidance to A/R team members
  • Support training and onboarding of new staff and vendor resources
  • Assist leadership in monitoring team performance, productivity, and quality metrics
  • Provide feedback and coaching to improve team performance
  • Reinforce best practices and standard workflows across the team

Vendor Oversight and Collaboration
  • Partner with RCM vendors to ensure alignment with organizational expectations and performance standards
  • Review vendor performance and identify gaps or improvement opportunities
  • Audit vendor-managed accounts to ensure appropriate follow-up and resolution
  • Escalate vendor performance concerns to leadership as needed

Compliance and Quality Assurance
  • Ensure all activities comply with payer guidelines, regulatory requirements, and internal policies
  • Maintain adherence to documentation standards and audit requirements
  • Participate in internal and external audits as required
  • Promote accuracy, accountability, and continuous improvement across workflows

Qualifications
  • High School Diploma or equivalent required
  • Associate's or Bachelor's degree in Healthcare Administration, Business, or related field preferred
  • 4-6 years of experience in medical accounts receivable, denial management, or insurance follow-up
  • Strong experience with claim follow-up, appeals, and payer communication
  • Familiarity with clearinghouses and electronic claim submission processes
  • Working knowledge of CMS guidelines and commercial payer policies
  • Experience with practice management systems

Performance Accountability / Key Performance Indicators (KPIs)
  • Days in A/R
  • Denial Rate
  • Appeal Success Rate
  • First-Pass Resolution Rate
  • Timely Follow-Up Rate
  • Rework / Correction Rate
  • Productivity (Accounts Worked per Day)

Skills & Competencies
  • Strong analytical and problem-solving skills with attention to detail
  • Ability to interpret EOBs, remittance data, and payer communications
  • Solid understanding of revenue cycle workflows and interdependencies
  • Ability to manage high-volume workloads and prioritize effectively
  • Strong organizational and time management skills
  • Effective communication skills for collaboration with internal teams and vendors
  • Commitment to accuracy, compliance, and accountability

Working Conditions
  • Remote or office-based environment
  • Must maintain a workspace that ensures confidentiality and minimal distraction
  • Regular use of computer systems and standard office equipment

Physical Requirements
  • Prolonged periods of sitting and working on a computer
  • Frequent use of hands and fingers for data entry
  • Ability to read, analyze, and interpret information on screens and documents

Additional Information
All your information will be kept confidential according to EEO guidelines.

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