Claims Research & Resolution Representative
New
Based in United StatesFull-TimeMiddle
Salary not disclosed
Apply NowOpens the employer's application page
Job Details
- Experience
- 1+ year
- Required Skills
- Data AnalysisCustomer service
Requirements
- 1+ year of experience in call center, customer service, or related support roles
- Experience in healthcare claims processing preferred
- Strong understanding of medical terminology and insurance processes preferred
- Bachelor’s degree is a plus
- Ability to analyze data and apply policies to real-world claim scenarios
- Strong communication and interpersonal skills for stakeholder interaction
- High attention to detail and ability to work with sensitive information
- Ability to work independently with limited supervision
- Intermediate mathematical and analytical skills
Responsibilities
- Manage end-to-end claims research, investigation, and resolution activities
- Review claim details, identify discrepancies, and determine appropriate outcomes
- Communicate with members, providers, and insurance carriers to resolve claim issues
- Apply policies, procedures, and regulatory guidelines to ensure accurate adjudication
- Approve or recommend claim settlements based on findings and authority level
- Document case progress, maintain records, and ensure timely claim closure
- Ensure confidentiality and compliance with healthcare and data protection standards
- Prioritize multiple claims while maintaining accuracy and meeting deadlines
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