case resolution specialist

NuStart Consulting

<div>Position: Claims Resolution Representative (DME)

Overview

The Claims Resolution Representative is responsible for identifying, correcting, and resolving DME claims that were billed inaccurately due to coding errors, payer discrepancies, or incorrect insurance information. This role ensures claims are properly corrected, rerouted to the appropriate payer, and successfully reimbursed. Complex denials requiring further review are escalated to the Appeals team.

Key Responsibilities
<ul><li>Analyze claims to determine root cause of misrouting or denial (e.g., incorrect payer, coding errors, eligibility issues)</li></ul>
<ul><li>Verify and update patient insurance information, including coordination of benefits (COB)</li></ul>
<ul><li>Review and validate coding accuracy (ICD-10, HCPCS, CPT as applicable)</li></ul>
<ul><li>Correct claim errors and ensure all required documentation is in place prior to resubmission</li></ul>
<ul><li>Resubmit corrected claims to the appropriate payer in a timely and accurate manner</li></ul>
<ul><li>Identify trends or recurring issues in claim errors and contribute to process improvement</li></ul>
<ul><li>Monitor claim status post-resubmission and follow up on pending or unresolved claims</li></ul>
<ul><li>Escalate complex denials or unresolved issues to the Appeals team as appropriate</li></ul>

Qualifications
<ul><li>Previous experience in within DME preferably with Surgical Dressings, Ostomy, Urological, Tracheostomy, etc.)</li></ul>
<ul><li>Strong understanding of Medicare guidelines, LCDs, and compliance requirements</li></ul>
<ul><li>Proficiency with medical billing systems and electronic claims submission platforms</li></ul>
<ul><li>Working knowledge of ICD-10, HCPCS, and CPT coding</li></ul>
<ul><li>Familiarity with CMS-1500 (professional claims)</li></ul>
<ul><li>Understanding of payer guidelines, claim frequency codes, and resubmission processes</li></ul>
<ul><li>High attention to detail with strong organizational and problem-solving skills</li></ul>
<ul><li>Strong communication skills and ability to work independently and within a team</li></ul>
<ul><li>Experience with Brightree is highly preferred</li></ul>
<ul><li>Minimum typing speed of 60 WPM</li></ul></div>

Claims Resolution Specialist

Liberty Mutual Insurance

<div>Description
<div>Are you looking to use your customer service skills in a role where you can see that you are making a difference in people&rsquo;s lives? Are you looking for a position that allows you to do meaningful and innovative work in a culture of continuous improvement? If so, this opportunity could be for you!
Liberty Mutual&rsquo;s Large Loss Claims Property team has an immediate opening for a Personal Property Claims Specialist. As a Claims Specialist, you will manage, investigate and resolve assigned Property Contents claims under general supervision. Responsibilities include: capturing and creating an inventory of damaged/lost contents while on site, working with various vendors and ensuring that quality customer service is provided via face to face and phone interaction. Manages, investigates and resolves assigned Property Contents claims for more complex claims under limited supervision. Compiles and values inventory of high-end damaged/lost contents associated with property claims. Provides policyholders with quality customer service. May assist Claims Representatives with in-person inspection/policyholder contact where necessary.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory.
To be successful in this role, the ideal candidate must be comfortable with travelling as he/she would be travelling 75% of the time, visiting homes and doing inspections/investigations.
Candidates who reside in Southern Illinois and Southwest Indiana are also welcome to apply for this role. 
Responsibilities:<ul><li>
Responsible for claims handling personal property losses to include large loss.</li><li>
Works in concert with large loss adjuster for scheduling, inventorying, adjustment and relocation assistance.</li><li>
Performs on-site inventory inspection and specific detail capture (50% minimum on-site) to provide to policyholder for pricing.</li><li>
Develops expert list/websites for various product categories.</li><li>
Utilizes internet VIA/Insurer's World/vendors for pricing and/or validation.</li><li>
Documents the file accordingly.</li><li>
Provides quality customer service.</li><li>
Provides insured with policy information to include coverage, limitations, replacement or ACV options.</li><li>
Works with and may coordinate a number of vendor services such as contractors, emergency repair, cleaning services and various replacement services.</li><li>
May assist on files handled by Claims Reps with in-person inspection/policyholder contact when needed.</li><li>
Attends product seminars/shows to build personal property expertise.</li><li>
May be called upon for catastrophe duty.</li></ul></div>
Qualifications<ul><li>
Strong written and oral communications skills required.</li><li>
Good interpersonal, analytical and negotiation skills required</li><li>
Customer service experience preferred</li><li>
Knowledge of coverages provided within various homeowner policies.</li><li>
Experience in interior design, electronics, appliances, antique-collectibles, clothing and furniture retail preferred.</li><li>
The capabilities, skills and knowledge required is normally acquired through a Bachelor&rsquo;s degree or equivalent experience and 3-5 years of directly related experience.</li><li>
Ability to obtain proper licensing as required.</li></ul>
About Us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role. 
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve. 
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits 
 
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law. 
 
Fair Chance Notices<ul><li>
California</li><li>
Los Angeles Incorporated</li><li>
Los Angeles Unincorporated</li><li>
Philadelphia</li><li>
San Francisco</li></ul></div>

Claim Resolution Specialist, Personal Property

dopay

<div>Key Responsibilities: 
 
Logistics &amp; Returns Specialist (PS)<ul><li>Incident Resolution: Spearhead the investigation of logistics failures (loss, damage, delays), driving cross-functional coordination to ensure 100% resolution within target SLAs.</li><li>Policy Governance: Audit all return shipments to ensure data integrity and physical compliance, acting as the final gatekeeper for logistics policy adherence.</li><li>Data Strategy: Maintain comprehensive audit trails and deliver actionable insights through daily/weekly performance reports on case health and throughput.</li><li>Strategic Escalation: Monitor aging cases using a risk-based approach, ensuring senior leadership is alerted to potential bottlenecks before they impact the customer.</li><li>Operational Compliance: Audit distribution point performance and DO activities through systematic validation of delivery evidence and service level agreements (SLAs).</li><li>Operational Intelligence: Analyze shipment data to identify courier performance gaps and process weaknesses, contributing to the continuous refinement of logistics SOPs.</li></ul> 
Requirements 
Skills &amp; Qualifications
Experience: 1 to 2 years in logistics operations, last-mile delivery, returns handling, or a related field.
Attention to Detail: High level of accuracy in case documentation, data entry, and audit record-keeping.
Communication: Good written and verbal communication skills to coordinate with courier partners and internal stakeholders.
Analytical Skills: Basic proficiency in Microsoft Excel to track case volumes, SLA timelines, and return data.
Organizational Skills: Ability to manage multiple open cases simultaneously and prioritize effectively in a fast-paced environment.
Technical Knowledge: Familiarity with logistics or courier management systems is an advantage.
Education: Bachelor's degree in Logistics, Supply Chain Management, Business Administration, or a related field. 
Benefits 
Why Join dopay?
Why Join dopay?<ul>
<li>Be part of a mission-driven company transforming payroll and financial inclusion in emerging markets.</li>
<li>A collaborative and inclusive work culture with opportunities for growth and career development.</li>
<li>Competitive salary and benefits package.</li>
<li>Opportunity to shape the future of financial technology in Egypt and beyond.</li>
</ul>Join us at dopay and be a part of a team that&rsquo;s transforming the financial landscape for the betterment of society in Egypt and beyond!-</div>

Logistics P.S & Returns Specialist

iMPROve Health

<div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div><div>About iMPROve Health
Come join the iMPROve Health team!
iMPROve Health is Michigan&rsquo;s Medicare-designated Quality Improvement Organization, and we&rsquo;re proud to be recognized as both a Cool Place to Work by Crain&rsquo;s Detroit Business (four years running) and one of Modern Healthcare&rsquo;s Best Places to Work in Healthcare.
As a nonprofit with more than 40 years of experience, we&rsquo;re dedicated to improving healthcare across the continuum of care using evidence-based, data-driven strategies. We provide medical consulting and review services, along with data analysis, to federal agencies, state Medicaid programs, public health organizations, healthcare facilities, private health plans, and other third-party payers. Our team also specializes in impartial utilization review, dispute resolution, and peer review. Our mission is simple: help healthcare get better.
This position is 100% remote, offering the flexibility to work from anywhere in the United States while collaborating with a supportive, nationwide team. We prioritize work/life balance and invest in our employees&rsquo; growth through professional development and continuing education opportunities. Our benefit package includes medical, dental, vision, life insurance, short- and long-term disability, and a generous 401(k) match.
At iMPROve Health, we are committed to improving the quality, safety, and efficiency of healthcare. While we do not provide direct patient care, our healthcare professionals&mdash;including physicians, nurses, and experienced consultants&mdash;partner with providers to promote the use of evidence-based best practices. We offer our clients a trusted, impartial resource that understands the complexities of the healthcare landscape and is dedicated to thoughtful, high-quality solutions.
Join us in making a meaningful impact on healthcare&mdash;one improvement at a time.
SUMMARY:
The Project Specialist assists with the daily workflow administrative responsibilities that support the Federal Independent Dispute Resolution Entity (IDRE) review process. The Project Specialist aids in facilitating the processing of IDR reviews and completes other duties as assigned under the direction of the IDR/IIDR Director and Program Manager. The specialist will work closely with the IDRE team and all reviewers to ensure case timeliness. Responsibilities also includes working with external customers to ensure receipt of all necessary review documentation.
DUTIES AND RESPONSIBILITIES:<ul><li>
Assist the team with facilitating review requests in a timely and efficient manner, including implementing processes to track and monitor individual case progress and timeliness.</li><li>
Collaborate with IDRE team members to achieve department goals, including prescreening IDR (Independent Dispute Resolution) cases for eligibility using defined criteria.</li><li>
Apply knowledge and experience in claims, appeals, and denials to support review and resolution processes, ensuring accuracy, compliance, and timeliness.</li><li>
Coordinate, document, and track pertinent data to meet team informational and reporting needs via various applications, including specific review and claims-related portals.</li><li>
Work closely with the administrative assistant to ensure receipt and completeness of all review documentation.</li><li>
Develop materials such as forms, email correspondence, manuals, articles, lists, invoices, charts, matrices, reports, records, schedules, templates, and other documents of similar complexity.</li><li>
Organize and support team planning, arranging, and coordinating specific meetings, workshops, programs, presentations, conferences, or other group events.</li><li>
Utilize advanced computer skills for daily work; responsibilities require constant computer usage and proficiency in software programs such as Microsoft Office, all Windows software products, and web-based portals.</li><li>
Participate in portal development and enhancements, including testing and feedback to improve functionality and user experience.</li><li>
Adhere to all relevant compliance regulations (Health Insurance Portability and Accountability Act, Federal Information Security Management Act, URAC, Centers for Medicare &amp; Medicaid Services, Federal Acquisition Regulation (FAR)).</li><li>
Complete other duties as assigned</li></ul>
EDUCATION AND/OR EXPERIENCE:<ul><li>
Associate&rsquo;s degree or five (5) years of related experience required; Bachelor&rsquo;s degree preferred (healthcare specialty preferred).</li><li>
Minimum two (2) years of project support experience in a corporate or professional environment required.</li><li>
Experience in IDR or claims, appeal, and denial processes preferred.</li><li>
Project management skills required.</li><li>
Strong communication skills, both verbal and written, required.</li><li>
Strong multi-tasking skills with attention to detail and deadlines required.</li></ul>
CORE COMPETENCIES:
Attention to detail, reliability, effective communication, collaboration, accountability, time management, and problem-solving.
This is a fully remote opportunity. 
EOE/VET/Disability</div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div></div> 
Monday - Friday 8 am to 5 pm EST</div>

PROJECT SPECIALIST - HEALTHCARE - REMOTE

Brock & Scott, PLLC

Earn $1,500+ per month in bonuses! Mostly inbound leads Grow your career with training and advancement opportunitiesAre you a motivated go-getter ready to make an impact?We&rsquo;re looking for energetic, results-driven individuals to join our collections team. Many people from a variety of backgrounds have succeeded in this role, so you don&rsquo;t need prior collections experience just a high school diploma, a positive attitude, and a drive to succeed.What You&rsquo;ll Do:<ul><li>Help consumers resolve accounts via phone, email, and mail</li><li>Handle inbound calls and assist with questions and payments</li><li>Track all communications and keep accurate account records</li><li>Recommend next steps and generate repayment documents when needed</li></ul>What We&rsquo;re Looking For:<ul><li>Clear, professional communication skills</li><li>Strong problem-solving and customer service abilities</li><li>Ability to work independently and meet goals</li><li>High school diploma or GED</li></ul>Why You&rsquo;ll Love It Here:<ul><li>Base Pay: $18.00/hour with no draw against your base</li><li>Bonus Potential: $1,500+ per month for on-target performers (performance-based; tied to goals and attendance)</li><li>Collaborative, supportive team environment</li><li>Career growth opportunities in a stable, growing company</li></ul>Ready to earn what you&rsquo;re worth and grow your career? Apply today!Job Type: Full-timePay: From $18.00 per hourBenefits:<ul><li>401(k)</li><li>AD&amp;D insurance</li><li>Dental insurance</li><li>Disability insurance</li><li>Employee assistance program</li><li>Flexible spending account</li><li>Health insurance</li><li>Life insurance</li><li>On-the-job training</li><li>Opportunities for advancement</li><li>Paid sick time</li><li>Paid time off</li><li>Paid training</li><li>Referral program</li><li>Vision insurance</li></ul>Work Location: In person

Collector / Resolution Specialist

Navancio LLC

Company: Navancio LLC Location: Remote, U.S.-based Position Type: Full-time Expected Hours: 40 hours per week Schedule: Monday&ndash;Friday, with availability during Eastern Time core business hours Openings: 2 Status: Contingent upon contract award and customer approval Compensation: $55,000 -$75,000About the RoleNavancio is seeking two Help Desk Specialist I team members to provide Tier 1 application support for users of a federal case management system. The Help Desk Specialist will receive, document, triage, troubleshoot, and track user-reported issues through resolution while coordinating with government subject matter experts and the technical delivery team.This role is ideal for customer-focused IT support professionals who are organized, responsive, and comfortable supporting a mission-critical application in a federal environment.Responsibilities&middot; Provide Tier 1 help desk and application support for user-reported issues, bugs, defects, and service requests.&middot; Log, update, categorize, prioritize, and track tickets using tools such as Jira, ServiceNow, or similar systems.&middot; Troubleshoot user issues, document resolution steps, and escalate unresolved issues through the appropriate support path.&middot; Coordinate with subject matter experts, business analysts, developers, QA staff, and technical leads to support ticket resolution.&middot; Maintain accurate ticket notes, status updates, internal references, and follow-up actions through closure.&middot; Help tag and catalog issues that may require development backlog review, defect remediation, or future enhancements.&middot; Support user account managers and stakeholders by documenting recurring issues, user needs, and process improvement opportunities.&middot; Provide clear, professional, and timely communication to users and internal team members.&middot; Learn the supported application, business processes, escalation model, and federal support requirements.Required Qualifications&middot; 1&ndash;3 years of experience in IT help desk, application support, customer support, service desk, or technical support.&middot; Experience using ticketing systems such as ServiceNow, Jira, Zendesk, Freshservice, Remedy, or similar.&middot; Strong customer service, troubleshooting, documentation, and follow-up skills.&middot; Ability to communicate clearly with users, technical staff, and leadership.&middot; Ability to learn complex business applications and follow documented support procedures.&middot; Ability to work remotely and collaborate with a distributed team during Eastern Time core business hours.&middot; U.S. citizenship required due to federal contract requirements.&middot; Ability to complete federal onboarding requirements, which may include background investigation, fingerprinting, and obtaining/maintaining a DoD Common Access Card (CAC), if required.Preferred Qualifications&middot; Experience supporting federal, DoD, law enforcement, justice, public safety, or case management applications.&middot; Experience with Tyler Technologies / Entellitrak or other configurable enterprise applications.&middot; Experience working with CAC-enabled systems or federal user environments.&middot; CompTIA A+, Network+, Security+, ITIL Foundation, or similar certification.&middot; Familiarity with basic SQL, application logs, or defect triage is a plus.Work Authorization and Federal RequirementsU.S. citizenship is required due to federal contract requirements. Selected candidates may be required to complete federal onboarding requirements, including background investigation, fingerprinting, annual cybersecurity training, a non-disclosure agreement, and obtaining/maintaining a DoD Common Access Card (CAC), as applicable.Equal Employment OpportunityNavancio LLC is an Equal Opportunity Employer. We consider qualified applicants without regard to race, color, religion, sex, national origin, disability, protected veteran status, age, or any other status protected by applicable law.Application InstructionsTo apply, please submit your resume and a brief summary of your relevant experience. Include the position title in your application materials.Pay: $55,000.00 - $75,000.00 per yearLicense/Certification:<ul><li>CompTIA A+, Network+, Security+, or similar certification (Preferred)</li></ul>Work Location: Remote

Help Desk Specialist I — Federal Application Support

Auto-Owners Insurance

<div>A career at Auto-Owners is challenging and rewarding. Our group of caring associates create financial security by helping individuals and businesses make a new start when a loss occurs.
Job Description
We offer a merit-based work-from-home program based on job responsibilities. After initial training in-person, you could have the flexibility of work-from-home time as defined by the leadership team.
 
 
Please note that we are not currently hiring fully remote positions. All candidates must have the ability to work in office.
Auto-Owners Insurance, a top-rated insurance carrier, is seeking motivated nursing professional to join our team. The position requires the person to:<ul><li>
Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the claimant&rsquo;s health across the care continuum.</li><li>
Coordinate care delivery and support among claimant support systems, including providers, community-based agencies, and family.</li><li>
Collaborate with claims associates to provide medical expertise in the investigation, evaluation, and appropriate resolution of injury claims including workers&rsquo; compensation, personal injury protection (no fault), and liability.</li><li>
Evaluate medical records for relatedness to the injury and appropriate utilization of medical treatment and services.</li><li>
Prepare and deliver trainings to claims staff via a variety of modalities including written materials, live presentations, WebEx and/or telephonic presentations.</li><li>
Identify opportunities, develop, and implement new clinical programs as well as improve existing programs and procedures.</li><li>
Assist in developing and maintaining vendor and consultant expectations and relationships.</li><li>
Negotiate rates with local healthcare providers including nursing homes, sub-acute facilities, and attendant care agencies.</li><li>
Assist with other duties in the clinical team department, or elsewhere, on request.</li></ul>
.
Desired Skills &amp; Experience<ul><li>
Active RN license in good standing required, BSN highly preferred.</li><li>
Certification in Case Management (CCM) required or to be obtained within 18 months of hire.</li><li>
Insurance Rehabilitation Specialist (CIRS), Disability Management Specialist (CDMS), Rehabilitation Nurse (CRRN), or Occupational Health Nurse (COHN) a plus.</li><li>
Minimum of three to five years clinical experience required. Strong clinical background in orthopedics, neurology, rehabilitation or trauma care is preferred. Insurance experience a plus.</li><li>
Minimum of three years experience as a case manager.</li><li>
Ability to communicate effectively in oral and written forms, read and interpret documents, and write routine reports and correspondence. Proficient computer skills including Microsoft Office products. Teaching or training experience a plus.</li><li>
Excellent problem resolution skills. This person should be able analyze details, make decisions, demonstrate innovativeness and continually seek more efficient ways to process and handle work for the benefit of the team.</li><li>
Excellent organizational skills with the ability to manage multiple priorities.</li></ul>
Benefits
Auto-Owners offers a wide range of career opportunities, and we are seeking talent that will help us continue our long tradition of success. We offer a friendly work environment, structured training program, employee mentoring and an excellent compensation/benefits package. Along with a competitive base salary, matched 401(k), fully-funded pension plan (once vested), and bonus programs, Auto-Owners also provides generous paid time off including holidays, vacation days, personal time, and sick leave. If you're looking to do rewarding work alongside great people, Auto-Owners is the place for you!<ul><li>Please note that the ability to work in the U.S. without current or future sponsorship is a requirement.</li></ul>
#LI-AT1 #LI-Onsite</div>

Nurse Case Manager

Search 10000+ Case resolution specialist jobs near you this May. New roles added regularly across leading industries. Apply today.