Claims Resolution Specialist

Job Summary

A company is looking for a Claims Resolution Specialist responsible for researching claim disputes and processing adjustments.

Key Responsibilities

• Researches and resolves claim disputes within contractual timeframes
• Acts as a liaison between members, providers, and internal claims departments
• Processes adjustments and maintains accurate documentation in the claims system

Required Qualifications, Training, and Education

• Experience in claims and customer service
• Proficient in Microsoft Office, particularly Excel
• Ability to navigate various computer claims and eligibility platforms
• Bachelor's degree preferred
• Bilingual skills preferred