Claims Resolution Specialist

Equian LLC Golden , CO 80403

Posted 8 months ago

The Claims Resolution Specialist will be responsible for:

  • Serve as first point of contact for handling inquiries of company product

  • Research account information

  • Answer high volume of incoming phone calls, voice mails, and emails in a professional and timely manner and according to company guidelines

  • Apply company policies and procedures to resolve a variety of issues

  • Coordinate and communicate with the Resolution Department Supervisor or Resolution & Appeals Divisional Managers, as required, to respond to inquiries

  • Close claims

  • Copy, scan, fax, save documentation in accordance with company standards

  • Update internal records in accordance with company standards

  • Maintain a daily log of provider calls, provider emails, and special assignments

  • Provide administrative support to the RAD Claim Representatives for appeal set-up on as-needed basis, in accordance with established processes and procedures

  • Participate in department and company meetings

  • Participate on committees and special projects (as assigned or required)

  • Meet time, quality, and customer satisfaction standards

  • Complete special projects as assigned, within required time standards

  • Understand, maintain, and apply HIPAA, confidentiality, and privacy standards to assigned work, as well as ERISA and fraud, waste and abuse laws


  • Strong verbal and written communication skills, including ability to listen effectively to understand the customers needs and communicate information clearly and effectively

  • Excellent knowledge of Microsoft Office (Word, Outlook, Excel, Power Point) and Adobe

  • Strong organizational, attention to detail, and follow-through skills

  • Strong problem-solving skills; ability to research and analyze information

  • Ability to prioritize and multi-task

  • Demonstrated time management skills

  • Ability to work independently and as part of a team

  • Team player demonstrating enthusiasm and commitment to company vision and mission

Optional skills:

  • Understanding of medical and healthcare terminology


  • 2+ years customer-facing work experience that includes handling incoming calls and emails, applying problem solving and research skills (healthcare field preferred but not required)

  • Answering phone calls, voice mails, and emails in a professional and timely manner according to company guidelines

  • Interacting with team members to assess needs, request clarification, and provide solutions

  • Familiarity with medical terminology, medical coding, or other medical-related experience helpful but not required

  • Composing emails and other written correspondence that are customer facing

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Claims Resolution Specialist

Equian LLC