CrawlJobs Logo

Claim Resolution Representative III

urmc.rochester.edu Logo

University of Rochester

Location Icon

Location:
United States of America , Rochester

Category Icon
Category:
Finance

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

19.62 - 26.49 USD / Hour
Save Job
Save Icon
Apply Position

Job Description:

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Responsibility:

  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts
  • Contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Researches and calculates under or overpaid claims
  • determines final resolution
  • Contacts payers on incorrectly paid claims completing resolution and adjudication
  • Adjusts accounts or processes insurance refund credits
  • Reviews and advises leadership on incorrectly paid claims from specific payers
  • Works with leadership on communication to payer representatives regarding payment trends and issues
  • Bills primary and secondary claims to insurance
  • Identifies and clarifies billing issues, payment variances, and/or trends that require management intervention
  • Assists department leadership with credit balances account reviews/resolutions and all audits
  • Coordinates response and resolution to Medicaid and Medicare credit balances
  • Requests insurance adjustments or retractions
  • Reviews and works all insurance credits in electronic health record
  • Enters electronic health record notes, documenting actions taken
  • Researches and responds to third party correspondence, receives phone calls, and explains policies and procedures involving routine and non-routine situations
  • Assists with patient related questions
  • Communicates and coordinates with other departments to resolve claim issues
  • Assists with all audits as needed
  • Other duties as assigned

Requirements:

  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience

Additional Information:

Job Posted:
February 20, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
Icon
University of Rochester - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Claim Resolution Representative III

New

Claim Resolution Representative III

Performs follow-up activities designed to bring all open account receivables to ...
Location
Location
United States of America , Albany
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claim resolution representative iii

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claim Resolution Representative III, Hospital/Private

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Albany
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claim Resolution Representative III, Hospital/Private

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claim Resolution Representative III

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower-level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claim Resolution Rep III

As a community, the University of Rochester is defined by a deep commitment to M...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience
Job Responsibility
Job Responsibility
  • Performs follow-up activities designed to bring all open account receivables to successful closure
  • Responsible for an effective claims follow-up to obtain maximum revenue collection
  • Researches, corrects, resubmits claims, submits appeals and takes timely and routine action to resolve unpaid claims
  • Resolves complex claims
  • Acts as a resource for lower level staff
  • Completes follow up activities on denied, unpaid, or underpaid accounts, as well as contacts payer representatives to research and resubmit rejected claims to obtain and verify insurance coverage
  • Follows up on unpaid accounts working claims
  • Reviews reasons for claim denial
  • Reviews payer website or contacts payer representatives to determine why claims are not paid
  • Determines steps necessary to secure payment and completes and documents follow up by resubmitting claim or deferring tasks
  • Fulltime
Read More
Arrow Right
New

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...
Location
Location
United States of America , Rochester
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate degree and 2 years of related relevant experience
  • or equivalent combination of education and/or experience
  • Excellent problem-solving skills
  • Excellent communication skills
  • Excellent customer service skills
Job Responsibility
Job Responsibility
  • Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
  • Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
  • Research claims, identify problems, and take appropriate action to assure claim resolution
  • Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
  • Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing
  • Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims
  • Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies
  • Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding
  • Escalates system issues preventing claims submission and follow-up for review and resolution
  • Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate
  • Fulltime
Read More
Arrow Right
New

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...
Location
Location
United States of America , Albany
Salary
Salary:
19.62 - 26.49 USD / Hour
urmc.rochester.edu Logo
University of Rochester
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Associate degree and 2 years of related relevant experience
  • or equivalent combination of education and/or experience
  • Excellent problem-solving skills
  • Excellent communication skills
  • Excellent customer service skills
Job Responsibility
Job Responsibility
  • Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
  • Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
  • Research claims, identify problems, and takes appropriate action to assure claim resolution
  • Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
  • Keeps management informed of changes in billing requirements and rejection or denial codes
  • Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists
  • Fulltime
Read More
Arrow Right
Jobs by Category
Art and Entertainment Jobs Banking Jobs Call Center Jobs Construction Jobs Consulting Jobs Customer Service Jobs Education Jobs Energy Jobs Finance Jobs Gastronomy Jobs Health and Beauty Jobs Hospitality and Tourism Jobs Human Resources Jobs Insurance Jobs IT - Administration Jobs IT - Software Development Jobs Legal Jobs Logistics Jobs Manufacturing Jobs Marketing, Digital Marketing, SEO, SEM Jobs Media Jobs Nursing Jobs Office Administration Jobs Pharmacy Jobs Physical Work Jobs Public Relations Jobs Public Sector Jobs Purchasing Jobs Quality Control Jobs Real Estate Jobs Research and Development Jobs Sales Jobs
Job Positions Jobs by Country
United States Jobs United Kingdom Jobs India Jobs Canada Jobs Australia Jobs Germany Jobs Ireland Jobs Poland Jobs
Company
Blog About Us Contact
Follow Us
Facebook
X (Twitter)
LinkedIn
Instagram
CrawlJobs Group
ITFlashcards AllDevBlogs
© 2026 CrawlJobs Ltd. All Rights Reserved
Terms & Conditions Privacy Policy