Claims Resolution Specialist (Customer Service)

Company: The Judge Group
Location: Orange
Posted on: September 14, 2022

Job Description:

Location: Orange, CA Description: The Judge Group is currently seeking a Claims Resolution Specialist (Customer Service) for one of our clients in Orange, CA! This job will have the following responsibilities:

• Address provider inquiries, questions, concerns in all areas including enrollment, claims submission and payment, benefit interpretation, and referrals/authorizations for medical care.
• Verifies member eligibility, claims, and authorization status for providers. -
• Responsible for thorough follow-up and completion of all providers inquires or requests.
• Outreaches to Health Network(s), providers, and collection agencies when appropriate to resolve claims billing, claims payment, and provider payment disputes. -
• Functions efficiently and productively in a high-volume call center while maintaining departmental productivity and quality standards. -
• Follows up with providers as needed. -
• Responsible for accurate, complete, and correct documentation into facets regarding all issues, inquiries, complaints, and grievances. -
• Routes escalated calls to the appropriate departments and/or supervisor. -
• Adheres to company and departmental policies and procedures. -
• Other duties or projects as assigned by management. Qualifications & Requirements:
  • 1+ year call center experience with high call volumes or customer service experience analyzing and solving provider claims problems required
  • 2+ years of claims experience required
  • Health Maintenance Organization (HMO), Medicare, Medicaid, and Health Services experience preferred If you'd be interested in this role and would like to learn more please email me at kgould@judge.com, or call my direct line at (214) 281-5946 for immediate consideration. Contact: This job and many more are available through The Judge Group. Find us on the web at

Keywords: The Judge Group, Orange , Claims Resolution Specialist (Customer Service), Other , Orange, California