Claims Resolution Specialist Jobs
Claims Resolution Specialist jobs are open across insurance, healthcare, financial services, and third-party administrators, at levels from entry-level associate to senior specialist and team lead, with specializations in medical billing disputes, property and casualty claims, and denial management. Scan the live roles below and apply to whichever ones fit.
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Showing 5 of 26+ Claims Resolution Specialist jobs
Under general supervision, assess and analyze inquiries related to medical claims/bills, authorizations and adjustments for payment or denial within contract agreement or regulatory requirements using knowledge or medical claim/bill payment processing and medical regulations. Investigates/researches claims that may require reprocessing due to system errors, contract changes, examiner errors, regulatory requirements or fee schedule changes. Coordinates with other health plan departments to correct data (e.g., benefit or systems errors) as necessary. Considers how actions contribute to quality outcomes and member/provider satisfaction.
Essential Responsibilities:
- Verify the intent of the inquiry: Utilizes knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-contracted pricing arrangements along with compliance with government regulations.
- Locate the necessary information relevant to the claim(s): Leverages information from the inquiry and using available resources.
- Determine how the related claim(s) was originally processed. Researches services rendered utilizing all available resources to determine if the claim was processed correctly. Researches denied claims utilizing all information available to determine if the claim was denied correctly.
- Make organizational determination: Use the information gained in steps 1, 2 and 3 to review the original claim outcome and determine if an adjustment is warranted.
- Document determination: Development of a clear and concise case summary, which may be subject to review.
- Take appropriate next steps to resolve the inquiry (e.g., adjust claim related pends and holds, policy, benefit or contract update/review, CHATS, CRM, Call Center or other organizational area education or closure of issue with no further action).
- Apply research findings across a broader population of claims with similar issues (benefit, contract, membership, etc.).
- Provide input regarding training and educational opportunities that aid in improving upstream processing accuracy and outcomes, identifying error trends.
- Research returned Kaiser Permanente claims payment checks and classify the reason for their return.
- Other duties may be assigned within department job functions.
Basic Qualifications:
- Minimum four (4) years of medical claims in an health plan environment adjudication experience (HMO, PPO, Indemnity environment). Which includes one (1) year of processing high complexity claims. IE: Adjustments, Transplants and High Dollar.
Education
- High School Diploma OR General Education Development (GED) required.
- N/A
- Basic PC skills.
- Working knowledge of Microsoft Word.
- Ability to work in a in a Labor Management Partnership environment.
- Customer service skills and the ability to understand Kaiser Permanente customer needs in a claims setting.
- Ability to apply procedures, practices and methods used in claims processing.
- Working Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).
- Ability to apply timely and accurate requirements of all state and federal regulatory guidelines.
- Ability to demonstrate complex problem solving and decision making.
- Working knowledge of Microsoft Excel.
- Demonstrated knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).
- AA degree, accounting or business related preferred.
PrimaryLocation : Colorado,Denver,Regional Office - Colorado
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri,
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : C01|SEIU|Local 105
Job Level : Entry Level
Job Category : Insurance
Department : Englewood MSSA Claims - National Claims Service Org - 1608
Travel : No
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Under general supervision, assess and analyze inquiries related to medical claims/bills, authorizations and adjustments for payment or denial within contract agreement or regulatory requirements using knowledge or medical claim/bill payment processing and medical regulations. Investigates/researches claims that may require reprocessing due to system errors, contract changes, examiner errors, regulatory requirements or fee schedule changes. Coordinates with other health plan departments to correct data (e.g., benefit or systems errors) as necessary. Considers how actions contribute to quality outcomes and member/provider satisfaction.
Essential Responsibilities:
- Verify the intent of the inquiry: Utilizes knowledge of organizational policies and procedures to ensure adherence to contractual agreements and non-contracted pricing arrangements along with compliance with government regulations.
- Locate the necessary information relevant to the claim(s): Leverages information from the inquiry and using available resources.
- Determine how the related claim(s) was originally processed. Researches services rendered utilizing all available resources to determine if the claim was processed correctly. Researches denied claims utilizing all information available to determine if the claim was denied correctly.
- Make organizational determination: Use the information gained in steps 1, 2 and 3 to review the original claim outcome and determine if an adjustment is warranted.
- Document determination: Development of a clear and concise case summary, which may be subject to review.
- Take appropriate next steps to resolve the inquiry (e.g., adjust claim related pends and holds, policy, benefit or contract update/review, CHATS, CRM, Call Center or other organizational area education or closure of issue with no further action).
- Apply research findings across a broader population of claims with similar issues (benefit, contract, membership, etc.).
- Provide input regarding training and educational opportunities that aid in improving upstream processing accuracy and outcomes, identifying error trends.
- Research returned Kaiser Permanente claims payment checks and classify the reason for their return.
- Other duties may be assigned within department job functions.
Basic Qualifications:
- Minimum four (4) years of medical claims in an health plan environment adjudication experience (HMO, PPO, Indemnity environment). Which includes one (1) year of processing high complexity claims. IE: Adjustments, Transplants and High Dollar.
Education
- High School Diploma OR General Education Development (GED) required.
- N/A
- Basic PC skills.
- Working knowledge of Microsoft Word.
- Ability to work in a in a Labor Management Partnership environment.
- Customer service skills and the ability to understand Kaiser Permanente customer needs in a claims setting.
- Ability to apply procedures, practices and methods used in claims processing.
- Working Knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).
- Ability to apply timely and accurate requirements of all state and federal regulatory guidelines.
- Ability to demonstrate complex problem solving and decision making.
- Working knowledge of Microsoft Excel.
- Demonstrated knowledge of medical terminology and international classification of Disease (ICD-10) and Current Procedure Terminology (CPT).
- AA degree, accounting or business related preferred.
PrimaryLocation : Colorado,Denver,Regional Office - Colorado
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri,
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 04:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : C01|SEIU|Local 105
Job Level : Entry Level
Job Category : Insurance
Department : Englewood MSSA Claims - National Claims Service Org - 1608
Travel : No
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Colorado Residents: In any materials you submit, you may redact or remove age-identifying information such as age, date of birth, or dates of school attendance or graduation. You will not be penalized for redacting or removing this information.
Claims Resolution Specialist Jobs by Experience Level
See All 26 Claims Resolution Specialist Jobs
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Find JobsClaims Resolution Specialist Job Market
Who's Hiring
- Liberty Mutual Insurance10
- Medlytix1
- Sedgwick1
- Caloptima1
- Alteva RCM1
Top Industries Hiring
- Insurance
What Employers Look For
The qualifications that appear most often in claims resolution specialist jobs.
- Two or more years of experience in claims processing, adjusting, or dispute resolution
- Proficiency with claims management software such as Xactimate, Facets, or TriZetto
- Knowledge of insurance policy language, coverage terms, and claims regulations
- Strong written and verbal communication skills for claimant and provider correspondence
- Associate or bachelor's degree in business, health administration, or a related field
- Adjuster license or relevant certification preferred in property and casualty or medical billing roles
Tips for Your Claims Resolution Specialist Job Search
Quantify your resolution outcomes on your resume
Hiring managers want to see what you actually resolved, not just that you handled claims. Include the volume of cases you worked, average turnaround times you met, and any denial overturn rates you improved. Generic duties-based bullets get filtered out fast.
Highlight your claims management software fluency
Many job postings screen for specific platforms like Xactimate, Facets, or TriZetto before a human even reads your resume. Name the systems you've used in a dedicated skills section so applicant tracking systems flag your application as a match.
Apply early to roles that fit
Migrate Mate lists claims resolution specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Target postings by claims type, not just title
Search for your specific specialty, whether that's workers' compensation, liability, medical billing, or property claims. Employers often prioritize candidates whose experience matches their claims category, so generic applications to mismatched roles rarely move forward.
Prepare for scenario-based interview questions
Interviewers in this field will walk you through a disputed claim scenario and ask how you'd resolve it. Practice explaining your investigation process, how you document decisions, and how you communicate outcomes to claimants and adjusters in clear, defensible terms.
Negotiate using your resolution efficiency data
When it comes time to discuss compensation, cite your measurable impact, like average case closure time or reversal rates, rather than years of experience alone. Employers in claims value demonstrated efficiency, and concrete performance data gives you a stronger basis than tenure.
Claims Resolution Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most claims resolution specialists?
The companies hiring the most claims resolution specialists right now include Liberty Mutual Insurance, Medlytix, and Sedgwick, with the largest share of openings in Florida, Arizona, and Texas, based on current listings on Migrate Mate as of November 2026. Insurance carriers, third-party administrators, and large health systems tend to post the most volume consistently.
How many claims resolution specialist jobs are remote?
About 83% of claims resolution specialist openings are fully remote or hybrid as of November 2026, with the highest remote share in medical billing dispute and denial management roles. Property and casualty adjuster positions are more likely to require on-site or field work, especially when physical inspections are part of the job.
How do you become a claims resolution specialist?
Start by building foundational knowledge in insurance, medical billing, or financial services through coursework or an entry-level claims assistant role. Get familiar with claims management software used in your target industry. Pursue relevant certifications such as a state adjuster license or a medical billing credential. Move into resolution-focused roles as you develop experience handling disputes and denials directly.
Can you get hired as a claims resolution specialist with little experience?
Yes, many employers hire candidates with limited direct experience if you can demonstrate transferable skills. Customer service roles that involved dispute resolution, billing, or account corrections are viewed favorably. Employers in healthcare billing are especially open to candidates from medical front-office or coding backgrounds. Emphasize attention to detail, written communication, and any exposure to policy documents or insurance terminology.
What does the claims resolution specialist interview process look like?
Most interviews include an initial phone screen focused on your background in claims or billing, followed by one or two rounds with a hiring manager or team lead. Expect scenario-based questions where you walk through how you'd investigate a disputed claim or communicate a denial decision. Some employers include a short written exercise to assess documentation clarity or policy interpretation.
Where can I find and apply to claims resolution specialist jobs?
You can find and apply to claims resolution specialist jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your claims specialty and experience level, then apply directly to each listing that fits.
See All 26 Claims Resolution Specialist Jobs
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