Claims Resolution Specialist

Are you a medical claims follow-up expert who thrives on solving problems, chasing down delayed payments, and driving clean claim resolution? A fast-growing healthcare organization is seeking a Claims Resolution Specialist with strong experience in insurance payer follow-up, revenue cycle operations, and medical billing workflows. If you excel at investigating claim issues, reducing aging accounts, and pushing claims toward timely reimbursement, this role is for you.

Position Overview

The Claims Resolution Specialist is responsible for persistent, proactive follow-up on submitted medical insurance claims to ensure accurate and timely payer adjudication. This role focuses on contacting insurance payers, resolving claim delays, identifying root-cause issues, escalating denials, and supporting overall revenue cycle improvement.

You will communicate directly with Medicare, Medicaid, commercial insurance, HMO/PPO plans, and other payers to ensure claims move smoothly through the adjudication process.

Key Responsibilities

• Perform insurance claims follow-up via phone, payer portals, email, and written communication
• Investigate claim status, payment delays, pending claims, and stalled claims
• Conduct persistent "nudge" follow-up to push claims through payer adjudication
• Identify and escalate claim denials, rejections, edits, and billing issues to internal analysts
• Document all payer correspondence, claim notes, status updates, and follow-up actions in internal systems
• Monitor claims aging, prioritize accounts by timelines, and meet departmental AR recovery targets
• Resolve eligibility, authorization, coding, and documentation issues when needed
• Maintain compliance with HIPAA, CMS guidelines, payer rules, and internal RCM workflows
• Communicate with patients, insurance companies, healthcare providers, and internal teams
• Support continuous improvement of the revenue cycle, claims processes, and payer relationships

Required Skills & Qualifications

• 2+ years of experience in claims follow-up, medical billing, AR recovery, insurance verification, or RCM
• Strong understanding of payer policies, EOBs, ERAs, remits, adjudication timelines, and claims processing
• Experience with Medicare, Medicaid, commercial insurance, HMO/PPO plans
• Familiarity with EMR/EHR systems, billing software, and payer portals
• Excellent verbal and written communication skills
• Highly organized, detail-oriented, and able to independently manage claim inventory
• Bachelor's degree preferred (or equivalent healthcare experience)

Compensation & Schedule

• Salary: $54,000 - $60,000 annually
• Schedule: Monday-Friday | 8:00 AM-4:30 PM (flexible)
• Work Environment: Hybrid
• Type: Temp-to-Hire after 90 days

Benefits During Contract Period

• Medical (MEC options)
• Pharmacy, virtual care & emotional support
• Dental, vision, accident & critical illness plans
• Life insurance & short-term disability
• Earned safe & sick time
• Employee discount programs

Benefits Upon Permanent Hire

• 96% employer-paid medical premium for employees
• Employer-paid portion of dependent coverage
• PTO, personal days, holidays
• Holiday + year-end bonuses
• 401(k) contribution + employee stock ownership after 3 months
• Dental, HSA (with employer contribution)

Why This Role Stands Out

• Hyrbid with strong work-life balance
• High-impact role within the revenue cycle team
• Opportunity to grow your career in claims resolution and RCM
• Collaborative culture, strong leadership, and mission-driven work