claims resolution specialist

Advantia health

<div>Advantia is seeking a Claims Resolution Specialist specializing in Lab Billing to join our team! As a Claims Resolution Specialist (Lab Billing), you will be essential in ensuring the accuracy and timeliness of billing and reimbursement for medical services. This important role demands a solid understanding of medical terminology, coding, and billing procedures. This role will report to the RCM Manager.
Job Responsibilities:
<ul><li>Initiating ERA (electronic remittance advice) set up with clearinghouse and/or third-party portals.</li><li>
Initiating EFT (electronic funds transfer) set up with payers &amp; third-party portals.</li><li>
Assist in vendor support of daily cash reconciliation duties.</li><li>
Clear understanding of RCM Payment Posting Processing (ERA/Manual Posting) of Line-Item Payments/Denials.</li><li>
Clear understanding of reconciling offset/recoupment payer remits.</li><li>
Call carriers and third parties to resolve unidentified payments/reconcile items.</li><li>
Responsible for maintaining payer portal admin and employee registration.</li><li>
Assist the RCM Manager with various projects.</li></ul>
Job Requirements:
<ul><li>High School/GED Education required</li><li>
Previous experience in medical billing or a related field is preferred.</li><li>
Proficiency in electronic health records and billing software preferred.</li><li>
Athena experience required.</li></ul>
Benefits &amp; Compensation: 
<ul><li>Health, Dental, and Vision Insurance</li><li>
Health Savings Account (HSA) and Flexible Savings Account (FSA) Option</li><li>
401k Retirement Plan</li><li>
Life and Disability Insurances</li><li>
Paid holidays/PTO</li></ul>
Please note: Advantia Health provides unparalleled healthcare to our customers by employing the most highly qualified individuals. If you are selected for further consideration, you will be subject to a background investigation. COVID-19 and Flu vaccination or an approved request for accommodation is required as a condition of employment.
Advantia Health is an Equal Opportunity Employer that is committed to global diversity: It is a place where good people want to work, and customers want to continue to engage EOE M/F/D/V.</div>

Claims Resolution Specialist - Lab Billing

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><h2 class="jobSectionHeader">Lead With Expertise. Deliver Impact That Matters. Grow With a Company That Invests in You.</h2>
At Liberty Mutual, we show up for people in their toughest moments, and we show up for our employees with the same commitment. Our Complex Casualty Claims Team is expanding, and we&rsquo;re seeking a Senior Claims Resolution Specialist who brings deep technical expertise, sharp critical thinking, and a passion for doing what&rsquo;s right. 
If you&rsquo;re energized by the challenge of managing high‑exposure, complex, and catastrophic injury claims, and you want to work in an environment where professionalism, integrity, and empathy guide everything we do, this is the role for you.<h2 class="jobSectionHeader">
 What Makes This Role Special</h2><h3 class="jobSectionHeader">
You Own the Complex Work</h3>
You&rsquo;ll be the point person on severe and catastrophic auto and homeowner&rsquo;s casualty claims, navigating litigation, partnering with counsel, and driving strategy.<h3 class="jobSectionHeader">
Your Expertise Is Valued</h3>
Your judgment plays a key role in shaping outcomes. You&rsquo;ll influence decisions on some of our most significant claims, backed by leaders who respect your experience.<h3 class="jobSectionHeader">
Flexibility Meets Purpose</h3>
This role is remote or hybrid depending on location, with only a modest two days a month expectation if you live near a hub.<h3 class="jobSectionHeader">
You&rsquo;ll Keep Growing</h3>
From advanced technical training to mentorship opportunities, we&rsquo;re dedicated to helping you expand your impact.<h3 class="jobSectionHeader">
Competitive Bonus Opportunity</h3>
External candidates with an active FL or TX All‑Lines Adjuster License (CEs current) may qualify for a $2,500 sign‑on bonus.<h1 class="jobSectionHeader">
What You&rsquo;ll Do</h1><ul><li>
Manage the investigation, evaluation, and resolution of complex auto and homeowner&rsquo;s casualty claims.</li><li>
Assess coverage, liability, and damages; recommend settlement strategies and escalate appropriately for authority review.</li><li>
Identifies potential suspicious claims and refers to SIU and identifies opportunities for third party subrogation.</li><li>
Collaborate closely with trial counsel; attend mediations, arbitrations, trials, hearings, and conferences.</li><li>
Prepare detailed litigation and trial reports for local management and Home Office.</li><li>
Communicate effectively with policyholders, witnesses, attorneys, and claimants to gather information and provide guidance.</li><li>
Responds to various written and telephone inquiries including status reports.</li><li>
Maintain accurate reserves, recommending increases on cases in excess of authority.</li><li>
Safeguard financial and confidential information across all claim files.</li><li>
Oversee billing practices of outside and in‑house counsel to ensure compliance and cost efficiency.</li><li>
May assist as a resource to the team, stepping in for the Claims Team Manager when needed or mentoring colleagues; or representing the company on matters involving state or federal regulatory agencies.</li><li>
Participate in special projects at the direction of leadership.</li></ul><h1 class="jobSectionHeader"> 
What You Bring</h1><h3 class="jobSectionHeader">
Ideal Experience Includes:</h3><ul><li>
5+ years managing complex and litigated casualty claims</li><li>
Deep expertise handling severe to catastrophic injuries and fatalities</li><li>
Strong analytical thinking, negotiation skills, and sound judgment</li><li>
Ability to thrive in a fast‑paced, high‑stakes environment</li><li>
Professionalism, empathy, and exceptional communication skills</li><li>
California and Arizona Casualty claims handling
</li></ul><h1 class="jobSectionHeader">Where You Can Work</h1>
If you live within 50 miles of one of our hub locations, the role is hybrid (2 days in office). Otherwise, it may be fully remote. Candidates located in the Central, Mountain, or Pacific time zones would be most ideal as this position supports claims located in CA and AZ. 
Hub Locations: 
Chandler, AZ 
Clifton Park, NY 
Columbus, OH 
Indianapolis, IN 
Lake Mary, FL 
Liberty Lake, WA 
Marlton, NJ 
Plano, TX 
Suwanee, GA 
Warrenville, IL 
Westborough, MA 
Travel: 10% for mediations, arbitrations, trials, or in‑person events.<h1 class="jobSectionHeader"> 
Training That Sets You Up for Success</h1>
Your growth begins on day one. Active engagement and reliable attendance during training are mandatory and crucial to your success in this high‑impact role.</div>
Qualifications<div><ul><li>
Must have an advanced knowledge of coverage, liability, and complex claims handling procedures.
</li><li>Must be knowledgeable of state and federal laws in the adjuster's jurisdiction.
</li><li>A full working knowledge of claims operations and procedures is required.
</li><li>Strong written and oral communication skills required as well as strong interpersonal, analytical, investigative, and negotiation skills.
</li><li>The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 5-7 years of directly related experience.
</li><li>Ability to obtain proper licensing as required.
</li></ul></div>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>

Senior Claims Resolution Specialist - Complex Casualty Southwest Region

Door County Medical Center

<div>The Claims Resolution Specialist submits claims to primary, secondary, and tertiary payers. Performs follow-up on all insurance open account balances. Researches credit balances for Medicare, Medicare HMO, Medicaid, and Medicaid HMO and handles appropriately. Handles all rejections/denials. Handles Hospital, Clinic, Rehab and Skilled Nursing Facility accounts. Epic experience preferred.

 Related Years of Experience Required: Two years&rsquo; experience in healthcare billing, or related experience.

 Shift: Working 40 hours a week, Monday- Friday.</div>

Claims Resolution Specialist - Patient Financial Services - 1.0 FTE (40 hours a week)

The Plastic Surgery Center

The Advanced Reconstructive Surgery Alliance (ARSA) and its affiliates are the largest Reconstructive Plastic Surgery medical practice in the country. Our expanding team of top tier physicians, coupled with our continued medical advancements, allows us to offer patients extraordinary clinical services with 5-star experience. We have a bold vision with a desire to revolutionize the industry; meeting patient needs while favorably transforming their lives. Common across the enterprise is not only the commitment to providing superior patient care, but to employee satisfaction and growth opportunities. It is a culture of teamwork, respect and appreciation for all employees&mdash;whether caring for patients directly or working in a support role.We are seeking a Claims Dispute Specialist.The Claims Dispute Coordinator manages and resolves complex medical claim disputes and appeals with a focus on compliance with the Federal No Surprises Act (NSA) and similar state surprise billing laws. This role requires strong written communication skills, analytical skills and attention to detail. The ideal candidate brings the ability to efficiently prepare strong written arguments based on complex medical claims while effectively managing dispute process deadlines.Key Responsibilities <ul><li>Review and analyze medical claims to ensure accuracy, compliance, and eligibility for appeal or dispute under the NSA or state law</li><li>Investigate claim payments and denials by reviewing clinical documentation, insurance payer contracts, and claim history</li><li>Initiate and manage disputes under the NSA or state law</li><li>Prepare clear and effective written arguments as part of claims dispute processes</li><li>Analyze data and identify insights to support negotiations and dispute arguments</li><li>Collaborate with various teams within ARSA to ensure timely and successful dispute resolution</li></ul>Qualifications and Experience <ul><li>1&ndash;3 years in healthcare claims processing preferred</li><li>Experience with No Surprises Act dispute resolution highly preferred</li><li>Bachelor&rsquo;s degree relevant field preferred</li></ul>Skills <ul><li>Strong analytical and problem-solving abilities</li><li>Strong written and verbal communication skills</li><li>Strong organization skills</li><li>Ability to manage multiple priorities and meet deadlines in a fast-paced environment</li><li>Proficiency in Microsoft Office suite and healthcare practice management systems</li></ul>Compensation &amp; Benefits:<ul><li>&middot; Pay Range: $55,000- $60,000annually</li><li>the starting rate within this range for this role varies depending on a number of factors, including a candidate&rsquo;s qualifications, skills, competencies, experience, and location.</li><li>&middot; Medical, Dental, Vision, Life, HSA and Long-Term Disability insurance</li><li>&middot; 401k and Profit sharing</li><li>&middot; Paid Time Off</li><li>&middot; Contribution to Health Benefits</li><li>Company Discounts on Products &amp; Services</li></ul>IND2Job Type: Full-timePay: $55,000.00 - $60,000.00 per yearExperience:<ul><li>Medical claims processinfg: 2 years (Required)</li><li>No Surprises Act: 2 years (Required)</li></ul>Ability to Commute:<ul><li>Red Bank, NJ 07701 (Required)</li></ul>Work Location: In person

Claims Dispute Specialist

CareSpot Urgent Care

<div><h1 class="jobSectionHeader">Position Summary</h1>
??The Revenue Cycle Specialist will be responsible for the day-to-day operation in the following areas: billing, Claims resolution, A/R follow-up, Credit Balance, EDI Billing, or Posting. Under the direction of the Manager the specialist will be responsible for handling all functions related to the designated area and any other duties assigned by management.???
<h1 class="jobSectionHeader">Duties and Responsibilities</h1>
<ul><li>??Responsible for claim submissions to Urgent Care payors in accordance with all insurance regulations and requirements.
</li><li>Process Urgent Care Payor credit card payments.
</li><li>?Provide all necessary documentation required by payors to resolve claim issues or denials, including medical records, prior authorizations, audits, etc.
</li><li>?Analyze and research all denials and over or under payments, with focus on Medicaid/Medicare.
</li><li>?Ensure all payor correspondence is reviewed and followed up on immediately.
</li><li>??Provide exceptional customer service and communication to payors and resolve any accounts receivable requests in a timely and accurate manner.
</li><li>?Communicate any issues to the Revenue Cycle Director\Management.
</li><li>Validate/Update unbilled Medicaid/Medicare unbilled charges, daily.</li>
<li>Act as the liaison between Omega and Centers for Urgent Care, Medicare and Medicaid focused, questions/issues.</li>
<li>Other duties and responsibilities as assigned.</li>
</ul>
?
?Please Note:?The list of responsibilities detailed above is not a comprehensive list, nor is it intended to be a list of all responsibilities and duties of the RCM specialist.?
<h1 class="jobSectionHeader">Experience, Skills and Education</h1>
<ul><li>??2+ years of relevant Healthcare billing experience within a healthcare facility or healthcare insurance company.
</li><li>?Deep understanding of medical billing rules and supporting documentation requirements for relevant Healthcare claims and remits.
</li><li>Medicaid and/or Medicare credentialing experience preferred, not required.</li>
<li>?Knowledge of ICD-10 and HCPC coding, modifiers, and other medical terminology.
</li><li>?Proficient with Microsoft Office, specifically Excel, Outlook, and Word.
</li><li>?NextGen experience a plus, but not a requirement.
</li><li>?High School diploma required.?</li>
<li>Ability to pass a Level II background screening and clearance through AHCA (Agency for Healthcare Administration) - https://info.flclearinghouse.com/</li>
</ul>
<h1 class="jobSectionHeader">Physical Demands</h1>
The physical demands and work environment characteristics described here are representative of those that must be met by a team member to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While working the essential functions of this job, the employee is occasionally required to stand, walk, sit, life, carry, use hands to handle or feel objects, tools or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds.
Work Environment
Admin - While performing the essential functions of the job the employee may be in office or work remotely dependent upon the company and/or department&rsquo;s policies.</div>

Specialist, Revenue Cycle - Onsite

<div><h1 class="jobSectionHeader">Who We Are</h1>
Join a team that puts its People First! Since 1889, First American (NYSE: FAF) has held an unwavering belief in its people. They are passionate about what they do, and we are equally passionate about fostering an environment where all feel welcome, supported, and empowered to be innovative and reach their full potential. Our inclusive, people-first culture has earned our company numerous accolades, including being named to the Fortune 100 Best Companies to Work For&reg; list for eleven consecutive years. We have also earned awards as a best place to work for women, diversity and LGBTQ+ employees, and have been included on more than 50 regional best places to work lists. First American will always strive to be a great place to work, for all. For more information, please visit www.careers.firstam.com.<h1 class="jobSectionHeader">
What We Do</h1>
Job Description 
Tired of those billable hour requirements? Not interested in business development and would rather focus on providing solutions to your cases? Want to be the decision maker rather than just an advisor? Want better work-life balance? Ready for a change with an in-house opportunity? 
 
We are seeking a Claims Counsel who will be responsible for investigating and handling claims to resolution. This is a hybrid position with three days in the Santa Ana office (Mondays, Tuesday and Thursdays).
What You'll Do:
<ul><li>Investigate, evaluate, determine loss and defense coverage liability and resolve claims</li><li>
Establish settlement and expense reserves</li><li>
Determine need to retain outside counsel</li><li>
Manage claims and/or litigation through to final resolution</li><li>
Negotiate with claimant / opposing counsel / third parties for resolution</li><li>
Attend mediations and other required court appearances / processes</li><li>
Review and approve invoices for costs and attorneys&rsquo; fees</li><li>
Perform / assist initial evaluation for recovery</li></ul> 
What You'll Bring:
<ul><li>Licensed to practice law in good standing</li><li>
Knows fundamental concepts, practices and procedures of particular field of specialization.</li><li>
Excellent communication, negotiation and organizational skills</li><li>
Law Degree required</li><li>
Admitted to practice law in US</li><li>
Typically has 2- 4 years professional experience in title insurance / title underwriting and knowledge on insurance claims and resolution</li></ul> 

Pay Range: $97,700.00 - $130,300.00 Annually 

This hiring range is a reasonable estimate of the base pay range for this position at the time of posting. Pay is based on a number of factors which may include job-related knowledge, skills, experience, business requirements and geographic location.<div><div><div><div><div><div><div> 
** Note that the following statements only apply to candidates who will be working from an unincorporated area within Los Angeles County. **</div></div></div></div></div></div></div>
First American will consider for employment all qualified applicants, including those with arrest or conviction records, in a manner consistent with the requirements of applicable state and local laws (e.g., the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act).
First American intends to conduct a review of an applicant&rsquo;s criminal history in connection with a conditional offer. First American reasonably believes that a criminal history may have a direct, adverse and negative relationship with the following material job duties for this position potentially resulting in the withdrawal of the conditional offer of employment: handling of confidential, proprietary or trade secret information belonging to First American or its customers, administrating or facilitating financial transactions, and the ability to meet customer-imposed criminal history requirements.<h1 class="jobSectionHeader">
What We Offer</h1>
By choice, we don&rsquo;t simply accept individuality &ndash; we embrace it, we support it, and we thrive on it! Our People First Culture celebrates diversity, equity and inclusion not simply because it&rsquo;s the right thing to do, but also because it&rsquo;s the key to our success. We are proud to foster an authentic and inclusive workplace For All. You are free and encouraged to bring your entire, unique self to work. First American is an equal opportunity employer in every sense of the term.
Based on eligibility, First American offers a comprehensive benefits package including medical, dental, vision, 401k, PTO/paid sick leave and other great benefits like an employee stock purchase plan.</div>

Claims Counsel - Title Insurance (Hybrid)

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