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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, 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

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