Claims Resolution Specialist

Job Summary

Working remotely from Pennsylvania, the full-time Claims Resolution Specialist will provide exceptional customer support for incoming and outgoing Provider Claims processing, ensuring compliance with established guidelines and collaborating across teams to manage competing priorities.

Key responsibilities

• Review, research, and process claims according to established processing guidelines
• Refer claims to appropriate departments and prepare Return to Provider (RTP) forms as needed
• Maintain accurate workload tracking and communicate status updates and challenges to leadership

Required qualifications

• Experience in healthcare insurance and/or medical claims
• Proficiency in Microsoft Office Suite
• Strong data entry and organizational skills, including knowledge of the Julian calendar
• Ability to read, interpret, and apply basic to moderately complex operating procedures
• Strong attention to detail and commitment to maintaining a consistent work schedule