Claims Resolution Specialist

We are looking for a Claims Resolution Specialist to support a non-profit organization with resolving a large volume of denied claims. This contract position is well suited for someone who combines strong customer service skills with experience in claims review, billing support, or insurance-related work. The person in this role will investigate denial reasons, coordinate next steps with the appropriate parties, and keep claim records organized and up to date. Initial training will be provided onsite, followed by primarily remote work for the remainder of the assignment.

Responsibilities:

• Examine denied healthcare claims in a high-volume queue and prioritize work to move cases toward resolution.

• Investigate the cause of claim denials by reviewing documentation, verifying details, and determining appropriate corrective actions.

• Record all updates, findings, and follow-up activities accurately to maintain complete and organized claim files.

• Communicate professionally with internal teams, payers, or other relevant contacts to gather information and support timely claim resolution.

• Handle sensitive medical and insurance information with discretion while delivering responsive customer service.

• Follow established workflows, quality expectations, and productivity targets throughout the contract assignment.

• Escalate complex or unresolved claim issues to the appropriate resource when additional review or intervention is needed

• At least 2 years of experience in a high call-volume customer service role.

• Proven ability to manage a heavy workload while maintaining accuracy and attention to detail.

• Comfort working across multiple systems, databases, and digital tools in a fast-paced environment.

• Solid problem-solving skills with the ability to research issues and determine appropriate next steps.

• Intermediate proficiency with Microsoft Office and general computer applications.

• Background in medical records, patient records, claims auditing, or call center support is helpful.

• Experience with denied claims, appeals, or healthcare insurance programs such as Medicare, Medicaid, VA, or commercial plans is preferred.