Claims Resolution Specialist

Job Summary

A company is looking for a Claims Resolution Specialist to support revenue cycle transformation by resolving complex insurance claims.

Key Responsibilities

• Investigate, analyze, and resolve complex, high-dollar claims that have been denied, underpaid, or delayed
• Prepare and submit comprehensive, payer-specific appeal packages and communicate with payer representatives
• Identify denial trends and contribute to process improvement efforts to enhance revenue cycle performance

Required Qualifications

• High School Diploma or GED
• 2 - 5 years of experience in medical billing, claims resolution, or revenue cycle operations
• Working knowledge of payer guidelines, appeals processes, and reimbursement methodologies
• Ability to navigate ambiguity and contribute in a fast-paced environment
• Strong attention to detail and commitment to accuracy and compliance