CrawlJobs Logo

Claims Resolution Specialist

firstam.com Logo

First American Financial

Location Icon

Location:
United States , Santa Rosa

Category Icon
Category:
Customer Service

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

32600.00 - 54300.00 USD / Year
Save Job
Save Icon
Apply Position

Job Description:

The Claims Resolution Specialist will respond to a high volume of second level incoming calls, resolve service requests and customer inquiries. Provide homeowners with all relevant information pertaining to the contract, claim or work order. Review claim and work order facts; gather, research and document pertinent information; take reports from technicians and homeowners to allow for sound, timely and cost effective decision making while taking action to drive the claim to closure and provide a high level of customer service. Intermediate levels require a solid understanding of functional tasks. Assistance may be required from more experienced team members will vary depending on task complexity. Work may be reviewed for new or more complex tasks.

Job Responsibility:

  • Take ownership of an assigned caseload from the investigation of the claim through resolution
  • Make decisions and authorize work orders up to a set level
  • Identify issues, analyze claim and work order facts, gather, review, research and document pertinent information
  • Take reports from technicians and homeowners
  • Answer incoming calls, emails and voicemails from customers, contractors and escalated calls in a timely manner and according to guidelines
  • Purchase necessary parts and equipment within a specified limit and skill set
  • Provide homeowners with all relevant information pertaining to contract, claim or work order
  • Obtain any necessary documentation from the customer and/or technician
  • Offer and explain terms and conditions of claim options, denial, cash out, replacement, reimbursement, outside reimbursement and process payment requests
  • Provide assistance with inbound call volume as needed
  • May purchase parts and equipment within a specified limit

Requirements:

  • High School Diploma
  • Must have at least 2 years of customer service experience in a contact center environment
  • Strong understanding of Home Warranty polices and technical expertise with systems and appliances
  • Ability to present data in a clear and understandable manner
  • Excellent verbal and written communications skills
  • Ability to anticipate customer needs
  • Exceptional customer service skills
  • Good organizational skills with the ability to multi-task, prioritize and follow up
  • Ability to effectively manage difficult situations and customers
  • Must be analytical and detail oriented
  • Working knowledge of Microsoft Office and company operating systems

Nice to have:

Fluent bilingual Spanish a plus

What we offer:
  • medical
  • dental
  • vision
  • 401k
  • PTO/paid sick leave
  • employee stock purchase plan

Additional Information:

Job Posted:
January 05, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Icon
First American Financial - 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 Claims Resolution Specialist

Claims Experience Specialist

The Claims Experience team is responsible for providing premium support for our ...
Location
Location
Canada
Salary
Salary:
63000.00 CAD / Year
airbnb.com Logo
Airbnb
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years in a fintech or customer experience role
  • Minimum of 1+ years experience handling insurance claims, preferably including first and third party property damage claims
  • Proficiency in both English and in French (must be able to handle technical claims discussions in French)
  • Critical thinking skills with a proven track record in solving challenging customer problems and making claims decisions with consistency and fairness whilst adhering to policy terms and workflows
  • Strong verbal and written communication skills with experience interacting with customers through multiple channels including email, messaging and phone
  • Active listening skills to understand user needs and provide personalized recommendations and assistance
  • Ability to explain complex and sensitive issues to customers with confidence and clarity
  • Analytical skills with the ability to organize and work independently with rapidly changing priorities
  • Negotiation skills to ensure customer issues are resolved in a timely and efficient manner
  • Solution and outcome-oriented with an ability to balance fraud prevention alongside a positive user experience
Job Responsibility
Job Responsibility
  • Evaluate, investigate and resolve claims submitted across our AirCover products (including but not limited to Host Damage Protection claims) including claims of high value and complexity that require complex investigation and negotiations to reach satisfactory outcomes
  • Closely monitor for fraud detection and mitigate risks associated with bad actors to protect the Airbnb brand and community
  • Verify all relevant facts and evidence to determine case resolution outcomes whilst following internal policies and workflows
  • Go above and beyond to create personalized interactions and exceptional premium support throughout the end-to-end claims process, tailoring the experience offered whilst ensuring each user’s needs and preferences are met with the highest level of care and attention
  • Provide continuous education and guidance for users about our Aircover products, terms and policies to enable the seamless resolution of their requests
  • Work closely with stakeholders and third party claims administrators to align on case strategies and ensure a timely resolution is reached for our users
  • Communicate regularly with Supervisors and Manager to provide feedback on the status of claims
  • Maintain high levels of confidentiality whilst conducting investigations
  • Identify gaps in workflow, process or policy whilst striving to provide upward feedback as required to further improve the experience for our customers
  • Act as subject matter expert for change initiatives and/or cross functional projects taking place across the Aircover Scaled Ops and Optimization org, including assisting internal stakeholders to test, refine, ideate, and deploy new internal products and processes
What we offer
What we offer
  • bonus
  • equity
  • benefits
  • Employee Travel Credits
  • Fulltime
Read More
Arrow Right

Property Claims Specialist

We’re working with a global broker known for handling complex risk. They’re look...
Location
Location
United Kingdom , Leeds
Salary
Salary:
40000.00 GBP / Year
https://www.lawesrecruitment.co.uk Logo
Lawes Consulting Group
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven track record of managing claims end-to-end
  • Familiar with domestic and/or commercial property policies
  • Experience with CMS platforms and Microsoft Office
Job Responsibility
Job Responsibility
  • Manage a portfolio of property claims from notification to resolution
  • Accurately assess policy coverage and determine liability
  • Liaise with loss adjusters, contractors, and customers
  • Ensure claims are settled efficiently, fairly, and within SLA
  • Maintain clear, accurate, and professional documentation
  • Escalate complex cases as needed, supporting a team-focused approach
  • Handle incoming claims and guide policyholders through the process
  • Investigate commercial property damage claims
  • Communicate regularly with stakeholders to keep claims moving
  • Collaborate with internal teams (underwriting, risk, customer care)
  • Fulltime
Read More
Arrow Right

Claims Experience Specialist

The Claims Experience team is responsible for providing premium support for our ...
Location
Location
Japan
Salary
Salary:
Not provided
airbnb.com Logo
Airbnb
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 5+ years in a fintech or customer experience role
  • Minimum of 1+ years experience handling insurance claims, preferably including first and third party property damage claims
  • Critical thinking skills with a proven track record in solving challenging customer problems and making claims decisions with consistency and fairness whilst adhering to policy terms and workflows
  • Strong verbal and written communication skills with experience interacting with customers through multiple channels including email, messaging and phone
  • Active listening skills to understand user needs and provide personalized recommendations and assistance
  • Ability to explain complex and sensitive issues to customers with confidence and clarity
  • Analytical skills with the ability to organize and work independently with rapidly changing priorities
  • Negotiation skills to ensure customer issues are resolved in a timely and efficient manner
  • Solution and outcome-oriented with an ability to balance fraud prevention alongside a positive user experience
  • Calm and Empathetic with ability to adapt to any situation by personalizing responses and educating our community whilst remaining level headed in challenging situations
Job Responsibility
Job Responsibility
  • Evaluate, investigate and resolve claims submitted across our Aircover products (including but not limited to Host Damage Protection claims) including claims of high value and complexity that require complex investigation and negotiations to reach satisfactory outcomes
  • Closely monitor for fraud detection and mitigate risks associated with bad actors to protect the Airbnb brand and community
  • Verify all relevant facts and evidence to determine case resolution outcomes whilst following internal policies and workflows
  • Go above and beyond to create personalized interactions and exceptional premium support throughout the end-to-end claims process, tailoring the experience offered whilst ensuring each user’s needs and preferences are met with the highest level of care and attention
  • Provide continuous education and guidance for users about our Aircover products, terms and policies to enable the seamless resolution of their requests
  • Work closely with stakeholders and third party claims administrators to align on case strategies and ensure a timely resolution is reached for our users
  • Communicate regularly with Supervisors and Manager to provide feedback on the status of claims
  • Maintain high levels of confidentiality whilst conducting investigations
  • Identify gaps in workflow, process or policy whilst striving to provide upward feedback as required to further improve the experience for our customers
  • Act as subject matter expert for change initiatives and/or cross functional projects taking place across the Aircover Scaled Ops and Optimization org, including assisting internal stakeholders to test, refine, ideate, and deploy new internal products and processes
  • Fulltime
Read More
Arrow Right

Manager, R&D Claim Enquiry & Resolution

This is a critical, high-impact role responsible for safeguarding the claims of ...
Location
Location
United Kingdom , London
Salary
Salary:
Not provided
empowerrd.com Logo
EmpowerRD
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven experience (3+ years) in UK R&D Tax Relief, with significant exposure to managing and successfully resolving HMRC enquiries or compliance checks
  • Strong technical understanding of R&D tax legislation (including SME and RDEC schemes) and the Department for Science, Innovation and Technology (DSIT) guidelines on R&D for tax purposes
  • Demonstrable experience in managing complex projects or a high-volume case portfolio simultaneously
  • Excellent written and verbal communication skills, specifically the ability to articulate complex technical and financial concepts to both HMRC and non-tax professionals
  • Strong commercial acumen and a pragmatic approach to dispute resolution
Job Responsibility
Job Responsibility
  • Manage the end-to-end portfolio of all active HMRC R&D tax credit enquiries, ensuring all statutory deadlines and internal SLAs are met
  • Develop, implement, and execute robust enquiry defence strategies for complex claims, focusing on technical and financial justifications in line with UK R&D legislation (CTA 2009/HMRC Guidelines)
  • Own and lead direct written and verbal correspondence and negotiations with HMRC caseworkers (ISBC/WMBC/Large Business Compliance Teams) to achieve timely and favourable closure notices
  • Review and quality-assure all documentation and supporting evidence (technical narratives, project costing, payroll, contracts) provided to HMRC to ensure it is clear, comprehensive, and addresses specific compliance risks
  • Manage and cultivate a flexible bank of external expert contractors (e.g., specialist engineers, sector-specific consultants, legal counsel) who can provide specialised technical evidence and support during enquiries
  • Define scopes of work, manage budgets, and oversee the output of all third-party experts to ensure their contribution aligns with the overall resolution strategy
  • Lead the internal feedback loop by analysing trends, common errors, HMRC concerns, and legislative risks identified during enquiries
  • Develop and deliver training sessions to the Claim Delivery and Sales teams, embedding new learnings and best practices back into our claims process and technology product
  • Proactively refine and update internal methodology and technical guidance to mitigate future enquiry risk and ensure all new claims are resilient and compliant
  • Support in reviewing technical narratives of ongoing claims to align with enquiry learnings
What we offer
What we offer
  • Competitive salary
  • generous holiday allowance
  • pension contribution
  • private healthcare
  • a commitment to continuous professional development
  • Fulltime
Read More
Arrow Right

Medical Billing Specialist

We are looking for a detail-oriented Medical Billing Specialist to join a team i...
Location
Location
United States , King of Prussia
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • At least 1 year of experience in medical billing, claims, or collections
  • Proficiency in accounting software systems and electronic health record (EHR) systems
  • Familiarity with Medicaid processes and commercial insurance claims
  • Strong understanding of accounts receivable, denial management, and appeals
  • Experience working with billing and authorization functions
  • Ability to accurately input and manage billing data
  • Excellent communication skills to collaborate with team members and external payors
  • Knowledge of compliance policies related to medical billing and collections
Job Responsibility
Job Responsibility
  • Process and submit primary and secondary claims for both commercial insurance and Medicaid
  • Investigate and resolve claim denials, performing appeals as necessary to ensure proper reimbursement
  • Manage accounts receivable by following up on claims through resolution, including correcting billing errors and addressing rejections
  • Input and review billing data for accuracy, ensuring compliance with company policies and procedures
  • Collaborate with the Billing Manager and clinic teams to ensure accurate and timely billing
  • Track and verify Medicaid status for clients while maintaining relationships with payors to facilitate successful claims processing
  • Assist intake teams with Medicaid documentation for new clients and those requiring reassessment
  • Utilize various insurance portals and systems, including Waystar, to handle denial responses and claims follow-ups
  • Ensure adherence to compliance standards in all billing and collections activities
  • Perform other tasks as assigned by the Billing Manager or Director
What we offer
What we offer
  • Medical insurance
  • Vision insurance
  • Dental insurance
  • Life insurance
  • Disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right

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

Medical Claims Resolution Specialist

We are seeking a detail-oriented Medical Claims Resolution Specialist within the...
Location
Location
United States , Indianapolis
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • 2+ years of experience in medical billing, claims resolution, accounts receivable, or revenue cycle operations
  • Must reside in the state of Indiana
Job Responsibility
Job Responsibility
  • Review and analyze denied, rejected, or outstanding medical claims to identify root causes
  • Research claim discrepancies, billing issues, coding errors, and payer requirements
  • Communicate with insurance companies, patients, and internal departments to resolve claim issues efficiently
  • Submit corrected claims, appeals, and supporting documentation as needed
  • Track claim status and maintain accurate documentation of follow-up actions and resolutions
  • Ensure compliance with payer guidelines, HIPAA, and company policies
  • Collaborate with billing, coding, and revenue cycle teams to improve claim resolution processes
  • Identify trends in denials and recommend process improvements
What we offer
What we offer
  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right
New

Senior AirCover Specialist

Airbnb was born in 2007 when two hosts welcomed three guests to their San Franci...
Location
Location
India , Gurugram
Salary
Salary:
880000.00 - 1030000.00 INR / Year
airbnb.com Logo
Airbnb
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Language proficiency in English. Be an advocate of high quality standards, innovation, resolution conflict and customer experience excellence. 1-3 years of experience in claims and dispute resolution, Insurance claims) conflict resolution, fraud or risk investigations, and/or crisis management. 2+ years of experience in customer service in international calling
  • handling escalations & have a critical thinking mindset. Excellent interpersonal and communication skills, both written (email) and spoken (phone), to help our community in a tactful and diplomatic manner. Excellent time management, negotiation and conflict resolution skills. Passion for innovation with a 'work smarter', solution and action oriented mindset. Experience working with internal stakeholders and/or third party providers to resolve complex disputes in a detailed, effective and timely manner. Calm and Empathetic - you are able to adapt to any situation by personalizing responses and educating our community while remaining level headed in tough situations. Ability to learn and adapt to new technologies
  • Working with leadership to develop and enhance internal policies, processes and tools. Bachelor's Degree or equivalent. Additional insurance investigation or program management experience are a plus. Experience handling insurance claims, especially in the field of first party property or liability claims is preferred. Understanding of 'Third Party Administrators/Adjusters' concepts is a plus
  • Media training or brand-risk management is a good to have. Experience with Partner or Vendor relationships is preferred.
Job Responsibility
Job Responsibility
  • Handle the designated inboxes through inbound and outbound tickets/emails, outbound calls and case work
  • Initiating, investigating and resolving cases involving complex damages, liability claims, potential fraud, or brand risk, verifying facts, and determining resolutions based on internal policies
  • Working closely with stakeholders to align on case strategy
  • Compiling incident reports at the direction of leadership
  • Providing upward feedback, regarding the status of claims, communicating regularly with supervisors and managers
  • Crafting clear and concise resolution plans in order to drive fair and accurate outcomes
  • Effectively collaborate with and monitor third party claims administrators
  • Mastering knowledge of company policies and procedures inside and out, being an expert in claims verification, payment processing, dispute resolution and fraud detection
  • Determining compensation and validity of the claims, identifying possible claim risks and/or liaising with other departments to de-escalate active threads
  • Maintaining high levels of confidentiality while performing investigations
What we offer
What we offer
  • bonus or incentives
  • one or more equity programs
  • benefits
  • Employee Travel Credits
  • Fulltime
Read More
Arrow Right