Claims Resolution Specialist

Job Summary

A company is looking for a Claims Resolution Specialist who engages with insurance carriers to negotiate reimbursement rates and resolve claims.

Key Responsibilities

• Engage and manage out-of-network underpaid claims with payers to secure favorable reimbursement rates
• Review and analyze claims against UCR rates and benchmark data to support maximum reimbursement
• Track and manage all appeal and negotiation activities, maintaining accurate documentation of negotiations and claim activities

Required Qualifications

• Minimum of 3 years of experience in medical billing, insurance follow-up, or revenue cycle operations
• Strong appeal and negotiation experience, preferably with out-of-network claims
• Understanding of out-of-network claims processing and reimbursement methodologies
• High School Diploma or equivalent required
• Experience with healthcare systems, payor portals, and billing platforms