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Resolution Management Jobs in California (NOW HIRING)

Currance Inc

Account Resolution Specialist III

Irvine, CA · On-site

$15.50 - $21.25/hr

As a healthcare revenue cycle business, we manage insurance claims and oversee timely claim resolution and payment processing for our clients. The Accounts Receivable Specialist III is a senior-level ...

BTAS

Acquisition Specialist

El Segundo, CA

$144K - $250K/yr

Demonstrates ability to manage all aspects of program financial management for an ACAT-like weapon system program, including but not limited to fiscal year planning, continuing resolution management ...

Enegra systems

Business Analyst (only W2)

Ventura, CA · On-site

... and resolution management Ability to identify a desired future state that addresses a business problem utilizing multiple analytic methodologies and business process modeling Ability to elicit and ...

Enegra Systems

Business Analyst (only W2)

Ventura, CA · On-site

... and resolution management Ability to identify a desired future state that addresses a business problem utilizing multiple analytic methodologies and business process modeling Ability to elicit and ...

Guardian Tax

Case Manager - Tax Resolution

Irvine, CA · On-site

$22 - $25/hr

Case Manager - Tax Resolution (Irvine, CA | In-Office) Guardian Tax is hiring an experienced Case ... Previous experience in case management * Strong communication skills * Excellent organizational ...

Guardian Tax

Case Manager - Tax Resolution

Irvine, CA

$22 - $25/hr

Case Manager - Tax Resolution (Irvine, CA | In-Office) Guardian Tax is hiring an experienced Case ... Previous experience in case management * Strong communication skills * Excellent organizational ...

BTAS

Acquisition Specialist

El Segundo, CA

$144K - $250K/yr

Demonstrates ability to manage all aspects of program financial management for an ACAT-like weapon system program, including but not limited to fiscal year planning, continuing resolution management ...

Guardian Tax

Case Manager Tax Resolution

Irvine, CA · On-site

$22 - $25/hr

Case Manager Tax Resolution (Irvine, CA | In-Office) Guardian Tax is hiring an experienced Case ... Previous experience in case management * Strong communication skills * Excellent organizational ...

Peter Holtz CPA

Tax Resolution Specialist

Roseville, CA · On-site

$58K - $76K/yr

We're looking for a Tax Resolution Specialist with experience in CDTFA matters and sales tax ... Ability to manage multiple client matters and deadlines simultaneously. * Experience in a CPA firm ...

BTAS

Program Management Senior Manager

El Segundo, CA · On-site

$163K - $281K/yr

Program Management Senior Manager LOCATION: El Segundo, CA REQUIRED SECURITY CLEARANCE: Active TS ... Coordinate and resolve issues and facilitate team communications including resolution of internal ...

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

To thrive in Resolution Management, you need strong analytical skills, problem-solving capabilities, and a background in conflict resolution or customer service, often supported by a relevant degree or certification. Familiarity with case management software, CRM systems, and incident tracking tools is typically required. Exceptional communication, emotional intelligence, and negotiation skills help you build rapport and effectively resolve disputes. These competencies ensure timely, fair, and satisfactory outcomes for all stakeholders, maintaining organizational integrity and customer trust.

How does a professional in Resolution Management typically collaborate with other departments to resolve complex issues?

Resolution Management professionals frequently serve as liaisons between customers, support teams, and other departments such as product, compliance, or legal. They must coordinate closely with these teams to gather relevant information, analyze root causes, and implement effective solutions. Successful collaboration often involves clear communication, timely updates, and a strong understanding of each department's workflow. This cross-functional teamwork ensures that complex issues are resolved efficiently and that all stakeholders are kept informed throughout the process.

What is Resolution Management?

Resolution Management refers to the process of identifying, addressing, and resolving issues, conflicts, or disputes within an organization or between parties. Professionals in this field use structured approaches to analyze problems, mediate between stakeholders, and implement solutions that prevent future recurrence. Their goal is to ensure smooth operations, maintain positive relationships, and support business objectives by minimizing disruptions caused by unresolved issues.

What is the difference between Resolution Management vs Customer Service Representative?

AspectResolution ManagementCustomer Service Representative
Primary RoleOversees and resolves complex customer issues, manages escalation processesHandles general customer inquiries, provides information, and resolves basic issues
Required SkillsProblem-solving, conflict resolution, communication, leadershipCommunication, patience, product knowledge, active listening
Work EnvironmentOffice settings, call centers, client-facing rolesCall centers, retail, online support channels
CertificationsCustomer service certifications, conflict resolution trainingCustomer service certifications often preferred

Resolution Management focuses on handling complex issues and managing escalation processes, often requiring specialized skills and certifications. Customer Service Representatives handle routine inquiries and basic problem resolution. While both roles involve customer interaction, Resolution Management typically involves higher-level problem-solving and oversight, making it suitable for those with advanced conflict resolution skills.

What are popular job titles related to Resolution Management jobs in California? For Resolution Management jobs in California, the most frequently searched job titles are:
What job categories do people searching Resolution Management jobs in California look for? The top searched job categories for Resolution Management jobs in California are:
What cities in California are hiring for Resolution Management jobs? Cities in California with the most Resolution Management job openings:
Resolution Management jobs near you
PROVIDER DISPUTE RESOLUTION SPECIALIST

PROVIDER DISPUTE RESOLUTION SPECIALIST

NORTH EAST MEDICAL SERVICES

Burlingame, CA

$42.79 - $48.75/hr

Other

Medical, Dental, Vision, Retirement

Posted 26 days ago

Job description

The MSO department seeks a PDR Specialist with strong verbal and written communication skills to handle provider disputes and appeals related to claims payments. This role involves researching, evaluating, and resolving claims disputes in line with regulations, policies, and industry standards. The specialist will also conduct root cause analyses, process claims readjustments, support system improvements, and manage the overpayment recoupment process.

The role requires an individual with strong analytic skills and critical thinking/problem solving skills. This individual must also have exceptional interpersonal skills to build and maintain positive working relationships.

Key Responsibilities:

  • Review and resolve provider payment disputes and appeals for Medi-Cal Managed Care, Medicare Advantage, and PACE programs.
  • Respond to complex provider inquiries regarding claims adjudication and payments.
  • Ensure timely and accurate resolutions to disputes per regulatory guidelines.
  • Maintain accurate records of dispute resolutions and update tracking systems.
  • Identify and correct claims payment errors, process adjustments, and handle provider overpayment refunds.
  • Analyze payment trends and escalate training or process improvement needs.
  • Assist with health plan audits and other projects related to provider dispute process as required.
  • Identify system configuration issues and report for resolution.
  • Performs other job duties as required by manager/supervisor and NEMS Management Team.
  • Bachelor’s degree preferred. Associate degree with relevant experience may be considered.
  • Minimum five years of experience in medical claims adjudication required.
  • Strong analytical, problem-solving, and communication (written & verbal) skills.
  • Knowledge of Medi-Cal & Medicare Advantage claims reimbursement and dispute resolution.
  • Familiarity with healthcare compliance (HIPAA, CMS, DHCS, AB1455).
  • Understanding of medical terminology, coding, and claim forms.
  • Detail-oriented with strong organizational and time management skills.
  • Proficiency in PC-based software and database management.

LANGUAGE:

  • Must be able to fluently speak, read and write English.
  • Fluent in other languages are an asset.

STATUS:

  • This is an FLSA Non-Exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position.


NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

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