Talent.com
Claims & Benefits Resolution Specialist
Claims & Benefits Resolution SpecialistKavaliro • West Valley City, UT, United States
serp_jobs.error_messages.no_longer_accepting
Claims & Benefits Resolution Specialist

Claims & Benefits Resolution Specialist

Kavaliro • West Valley City, UT, United States
job_description.job_card.1_day_ago
serp_jobs.job_preview.job_type
  • serp_jobs.job_card.full_time
job_description.job_card.job_description

Job Title

Claims & Benefits Resolution Specialist

Pay Rate

$25.00-$26.00

Start Date

12-22-2025

Location

West Valley City, UT 84120

(Training Onsite; Remote After Training with 1 Required Onsite Day / Month)

Department : Revenue Cycle Management – Central Business Office

Assignment Length

3 Months (Potential Extension)

Top Things Needed :

  • Minimum 2–3 years of experience in healthcare revenue cycle, claims processing, eligibility / benefits, or authorizations.
  • Strong understanding of payer rules, reimbursement methodologies, and claims adjudication.
  • Familiarity with Epic, payer portals, and other claims / RCM systems.
  • High accuracy in auditing and error resolution work.
  • Experience resolving complex claim issues across multiple systems.
  • Ability to work independently, troubleshoot problems, and drive claims to completion
  • Strong communication skills for interacting with payers, internal teams, and leadership.
  • Comfortable with onsite onboarding and required monthly onsite days.
  • Experience working in a Central Business Office or Shared Services model.
  • Prior experience supporting Utah-based payer populations or multi-state payer networks.

JOB DESCRIPTION :

Our client is seeking a Claims & Benefits Resolution Specialist for a contract opportunity. This role performs comprehensive audits and resolution activities across the claims lifecycle, ensuring accurate billing, timely reimbursement, and compliance with payer requirements. The specialist will handle complex claim discrepancies, conduct follow-up with payers, and coordinate with clinical and non-clinical teams to finalize claim determinations. The ideal candidate has strong revenue cycle experience, particularly in claims, eligibility, benefits, and authorizations, and can quickly identify root-cause errors in a high-volume environment.

This is an operational "fix-it" position — the manager needs someone who doesn't just process claims but can find what's broken and correct it without hand-holding.

Key Responsibilities

  • Claims Audit & Correction
  • Perform comprehensive audits on assigned accounts to identify billing, payment, and adjustment errors.
  • Correct claim discrepancies within established turnaround times.
  • Ensure claim data accuracy, compliant coding, and alignment with the member's plan benefit.
  • Timely & Accurate Claims Processing
  • Process claims quickly and accurately according to organizational benchmarks.
  • Apply reimbursement rules based on the member's benefits and plan specifications.
  • Validate supporting documentation needed for accurate processing (eligibility, benefits, authorizations, etc.).
  • Complex Follow-Up & Dispute Resolution
  • Conduct follow-up on delayed, denied, or pended claims; escalate unresolved items as needed.
  • Investigate processing delays, missing information, or system errors and implement corrective action.
  • Refer cases to clinical management teams when medical review is required to ensure appropriate reimbursement.
  • Eligibility, Benefits & Authorization Coordination
  • Verify and document member eligibility, benefits coverage, and authorization requirements.
  • Identify discrepancies in coverage or authorizations that impact payment determinations.
  • Communicate directly with payers or internal departments to resolve missing or inconsistent benefit information.
  • Cross-Functional Collaboration
  • Work closely with leadership, clinical review staff, and the CBO team to ensure timely resolution of claim issues.
  • Participate in problem-solving discussions related to claim trends or systemic issues.
  • Support training and onboarding efforts as needed during onsite sessions.
  • Required Skills & Experience

  • Minimum 2–3 years of experience in healthcare revenue cycle, claims processing, eligibility / benefits, or authorizations.
  • Strong understanding of payer rules, reimbursement methodologies, and claims adjudication.
  • Familiarity with Epic, payer portals, and other claims / RCM systems.
  • High accuracy in auditing and error resolution work.
  • Experience resolving complex claim issues across multiple systems.
  • Ability to work independently, troubleshoot problems, and drive claims to completion
  • Strong communication skills for interacting with payers, internal teams, and leadership.
  • Comfortable with onsite onboarding and required monthly onsite days.
  • Experience working in a Central Business Office or Shared Services model.
  • Prior experience supporting Utah-based payer populations or multi-state payer networks.
  • serp_jobs.job_alerts.create_a_job

    Benefit Specialist • West Valley City, UT, United States

    Job_description.internal_linking.related_jobs
    Benefits Specialist

    Benefits Specialist

    Interview Hunters • West Valley City, UT, US
    serp_jobs.job_card.full_time
    serp_jobs.filters_job_card.quick_apply
    We are looking for a representative to join our team.This person will operate as the lead on all critical business accounts. The focus of this vital role is to manage the relationship with the clien...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Business Systems Analyst - Claims

    Business Systems Analyst - Claims

    AmTrust Financial • South Jordan, UT, United States
    serp_jobs.job_card.full_time
    Business Systems Analyst - Claims.US-OH-Cleveland | US-UT-South Jordan | US-TX-Dallas.The Business Analyst is a part of the Claims Product Management / Execution group that supports outlining and imp...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    Flexible Remote Work – Get Paid to Share Your Opinions on Top Brands

    OCPA • Eagle Mountain, Utah, us
    serp_jobs.filters.remote
    serp_jobs.job_card.part_time +1
    Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies. We guarantee 15-25 hours per week with an hourly pay of bet...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Site Reliability Engineer

    Site Reliability Engineer

    Podium • Lehi, Utah, United States
    serp_jobs.job_card.full_time
    At Podium, our mission is to arm every local business with a complete platform and outcome-driven AI employees that convert leads into real, paying customers. Every day, millions of workers use our ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Senior Team Lead, Coordination of Benefits

    Senior Team Lead, Coordination of Benefits

    Collective Health • Lehi, Utah, USA
    serp_jobs.job_card.full_time
    At Collective Health were transforming how employers and their people engage with their health benefits by seamlessly integrating cutting-edge technology compassionate service and world-class user ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Remote Customer Service Representative – Product Testing

    Remote Customer Service Representative – Product Testing

    GLOCPA • Bluffdale, Utah
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    We’re looking for Customer Support Product Testers across the US to work from home and help top brands improve their products before they hit the market.serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Claim Specialist - Property Field Inspection

    Claim Specialist - Property Field Inspection

    State Farm • Salt Lake City, UT, United States
    serp_jobs.job_card.full_time
    Being good neighbors - helping people, investing in our communities, and making the world a better place - is who we are at State Farm. It is at the core of how we operate and the reason for our suc...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Insurance Benefits Specialist- 100% Remote

    Insurance Benefits Specialist- 100% Remote

    Global Elite • Lehi, Utah, United States, 84043
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Insurance Benefits Specialist- 100% Remote.ALL BENEFITS REPRESENTATIVES START AT ENTRY LEVEL AND MOVE UP!.Suggested schedule of success to get you paid EACH WEEK!. AO is looking for an entry level i...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30
    Territory Underwriting Specialist - Utah

    Territory Underwriting Specialist - Utah

    Sentry Insurance • Salt Lake City, UT, United States
    serp_jobs.job_card.full_time
    Market products and services to assigned Commercial Lines accounts and agencies, leading underwriting and selecting agencies, developing and maintaining relationships. Territory Underwriter Speciali...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Specialist, Appeals & Grievances

    Specialist, Appeals & Grievances

    Molina Healthcare • West Valley City, UT, US
    serp_jobs.job_card.full_time
    Member And Provider Complaint Resolution Specialist.Responsible for reviewing and resolving member and provider complaints and communicating resolution to members and provider (or authorized repres...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Reimbursement Specialist, Insurance Billing (Remote)

    Reimbursement Specialist, Insurance Billing (Remote)

    Myriad Genetics • Salt Lake City, UT, United States
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    The Reimbursement Specialist is responsible for collecting on all outstanding balances for a specific group of payors to ensure maximum reimbursement. This is a US based remote position.It requires ...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Pharmacist - Relocation Assistance Available

    Pharmacist - Relocation Assistance Available

    WALGREENS • Saratoga Springs, Utah, US
    serp_jobs.job_card.full_time
    Join Our Team at Walgreens as a Pharmacist! Why Walgreens - For You, For Your Family, For Your Future At Walgreens, pharmacists are medication experts and trusted healthcare providers reshaping th...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Flexible Work From Home - Supplement Your Income

    Flexible Work From Home - Supplement Your Income

    Finance Buzz • Lehi, Utah, US
    serp_jobs.filters.remote
    serp_jobs.job_card.temporary
    We’re seeking reliable and motivated individuals who want to earn extra income from home.This flexible position allows you to set your own hours and work around your existing commitments.Are you th...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Specialist, Claims Recovery (Remote)

    Specialist, Claims Recovery (Remote)

    Remote Staffing • Salt Lake City, UT, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Provides support for claims recovery activities including researching claim payment and billing guidelines, audit results, and federal regulations to determine overpayment accuracy and provider com...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Personal Effects Claims Specialist

    Personal Effects Claims Specialist

    Hub International Insurance • Salt Lake, Utah, USA
    serp_jobs.job_card.full_time
    Specialty Program Group (SPG) is the wholesale & MGA division of HUB International.SPG acts in a holding company capacity acquiring best-in-class underwriting businesses to operate independentl...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
    Customer Service / Benefits Advisor (Work from home)

    Customer Service / Benefits Advisor (Work from home)

    Professional Career Solutions • Lehi, Utah
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time +1
    We're looking for candidates with great customer service skills to fill our Remote Customer Service role!.This role is entirely remote and offers full-time / Part time hours with flexibility.We are r...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Senior Environmental Technical Claims Specialist

    Senior Environmental Technical Claims Specialist

    Argonaut Management Services, Inc • Salt Lake City, UT, United States
    serp_jobs.job_card.full_time
    Argo Group International Holdings, Inc.American National, US based specialty P&C companies, (together known as BP&C, Inc. Brookfield Wealth Solutions, Ltd.BWS"), a New York and Toronto-listed public...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
    Remote Claims Adjusters, Examiners, and Investigators - AI Trainer ($60-$100 per hour)

    Remote Claims Adjusters, Examiners, and Investigators - AI Trainer ($60-$100 per hour)

    Mercor • Lehi, Utah, US
    serp_jobs.filters.remote
    serp_jobs.job_card.full_time
    Role Overview • •Mercor is collaborating with a top-tier AI research group to model real-world claims workflows for property and casualty insurance. We are seeking experienced independent contractors—...serp_jobs.internal_linking.show_more
    serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted