Claims Resolution Specialist

Healthcare Claims Resolution Specialist

Fully Remote
$67,000-$75,000 annually
Monday-Friday | Full-Time
Temp-to-Hire

Position Overview

We're seeking a detail-oriented Claims Resolution Specialist to support payer audits, appeals, contracting activities, compliance efforts, and operational process improvements. This role will be responsible for analyzing payer policies, resolving reimbursement and documentation issues, supporting contract administration, and partnering with internal teams to ensure efficient and compliant payer operations.

This opportunity is ideal for someone with healthcare payer experience who enjoys problem-solving, process improvement, and working cross-functionally to drive operational excellence.

Key Responsibilities

• Manage payer audits and post-audit appeal activities.
• Analyze and resolve payer policy, documentation, and claims-related discrepancies.
• Support payer contracting initiatives and contract administration processes.
• Investigate and assist in resolving pricing discrepancies and reimbursement variances.
• Track payer cases, contracts, and escalations using Salesforce.
• Review payer policies and contracts to ensure regulatory compliance.
• Collaborate with internal teams to resolve complex payer and operational issues.
• Ensure documentation is accurate, complete, and aligned with payer requirements.
• Identify opportunities to improve workflows, reporting, and operational efficiency.
• Build and maintain productive relationships with payer representatives.
• Monitor industry trends, regulatory changes, and payer best practices.
• Provide additional support across payer operations and contracting functions as needed.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, or a related field.
• 3+ years of experience in payer operations, healthcare policy analysis, managed care, revenue cycle, or a related healthcare setting.
• Strong knowledge of Medicare, Medicaid, and commercial payer policies.
• Experience handling denials, appeals, grievances, audit preparation, and post-audit responses.
• Experience supporting payer contracts and resolving contract-related discrepancies.
• Proficiency with Salesforce, including case management, workflow tracking, and reporting.
• Strong analytical, organizational, and problem-solving abilities.
• Knowledge of HIPAA, CMS guidelines, and healthcare compliance regulations.
• Excellent communication and collaboration skills.
• Experience with payer systems is preferred.

Why Join Us?

• Fully remote work environment with scheduling flexibility.
• Competitive compensation and comprehensive benefits package.
• Generous paid time off and holiday schedule.
• Medical, dental, and vision coverage.
• Retirement savings program with employer contributions.
• Wellness and lifestyle reimbursement opportunities.
• Tuition assistance and professional development support.
• Employee ownership and performance incentive opportunities.
• Collaborative, mission-driven culture focused on innovation and continuous improvement.
• Strong potential for long-term career growth and advancement.

If you're passionate about healthcare operations, payer strategy, compliance, and process improvement, we'd love to hear from you.

All qualified applicants will receive consideration for employment without regard to race, color, national origin, age, ancestry, religion, sex, sexual orientation, gender identity, gender expression, marital status, disability, medical condition, genetic information, pregnancy, or military or veteran status. We consider all qualified applicants, including those with criminal histories, in a manner consistent with state and local laws, including the California Fair Chance Act, City of Los Angeles' Fair Chance Initiative for Hiring Ordinance, Los Angeles County Fair Chance Ordinance, and San Francisco Fair Chance Ordinance.