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Resolution Processing Jobs in California (NOW HIRING)

Currance Inc

Account Resolution Specialist III

Irvine, CA · On-site

$21 - $23.50/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 ...

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 ...

Mercury

Disputes Specialist

San Francisco, CA · On-site +1

$75K - $85K/yr

Handle dispute intake and resolution processes, including pre-arbitration and arbitration cases, as well as ACH disputes * Work with our partners and internal team members to review and assess ...

Gallagher

Senior Resolution Manager

Sacramento, CA · Remote

Whether you're managing claims, supporting clients, or improving processes, you'll play a vital ... resolution. * Provide exceptional customer service to our claimants on behalf of our clients ...

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All JobsResolution Processing JobsResolution Processing Jobs in California

Resolution Processing information

What is the difference between Resolution Processing vs Claims Processor?

AspectResolution ProcessingClaims Processor
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or claims processing certificationsHigh school diploma or equivalent; often requires insurance or claims processing certifications
Work EnvironmentOffice settings, call centers, or remote work; primarily administrative and customer serviceOffice or remote; handling insurance claims, data entry, and customer communication
Industry UsageInsurance, healthcare, financeInsurance, healthcare, government agencies
Common Search/ComparisonResolution Processing vs Claims Processor

Resolution Processing and Claims Processors both handle insurance-related tasks, often in similar environments. Resolution Processing typically focuses on resolving claims issues, discrepancies, or appeals, while Claims Processors primarily review and process insurance claims from submission to payout. Both roles require similar credentials and are used across insurance and healthcare industries. Understanding their differences helps job seekers identify the right career path within the claims and resolution field.

What are popular job titles related to Resolution Processing jobs in California? For Resolution Processing jobs in California, the most frequently searched job titles are:
What job categories do people searching Resolution Processing jobs in California look for? The top searched job categories for Resolution Processing jobs in California are:
What cities in California are hiring for Resolution Processing jobs? Cities in California with the most Resolution Processing job openings:
Resolution Processing 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 27 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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