How To Become A Claims Resolution Specialist: What It Is and Career Path

What is a claims resolution specialist and how to become one

Updated January 8, 2025

4 min read

Unfortunately, insurance claims don't always get approved, even if they are truly deserved. However, all hope is not lost for a denied claim, and filers may still have a chance to get coverage. This is where claims resolutions specialists step in.

The main duties of a claims resolution specialist are researching claim denials, submitting appeals, following up on outstanding claims, and handling claims correspondence. In short, they resolve outstanding claims for clients or patients, often through a host of different techniques in insurance applications, appeals, and more.

Claims resolutions specialists are typically required to have at least an associate's degree or a two-year equivalent from a technical school. Knowledge of medical terminology, insurance and appeals processes, as well as medical record management, are a must. On top of that, most employers also require at least six months of relevant experience, training, or both.

The average salary of a claims resolution specialist is $15 an hour or $30,000 a year. Claims resolution specialists that have additional relevant training have the potential to earn higher.

ScoreClaims Resolution SpecialistUS Average

Salary

3.0

Avg. Salary $38,432

Avg. Salary $59,228

Stability level

5.9

Growth rate -4%

Growth rate 0.3%

Diversity

9.2

Race

American Indian and Alaska Native 0.64%

Asian 6.20%

Black or African American 11.42%

Hispanic or Latino 20.64%

Unknown 5.05%

White 56.04%

Gender

female 74.04%

male 25.96%

Age - 39

Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 39

Stress level

5.9

Stress level is manageable

7.1 - high

Complexity level

6.6

Complexity level is challenging

7 - challenging

Work life balance

6.5

Work life balance is good

6.4 - fair

Key steps to become a claims resolution specialist

Explore claims resolution specialist education requirements

Most common claims resolution specialist degrees

Bachelor's

51.7 %

Associate

19.3 %

High School Diploma

11.6 %

Start to develop specific claims resolution specialist skills

Skills	Percentages
Patients	12.92%
Medical Terminology	6.68%
Insurance Claims	6.23%
Patient Accounts	5.41%
Medicaid	5.28%

Complete relevant claims resolution specialist training and internships

Accountants spend an average of 6-12 months on post-employment, on-the-job training. New claims resolution specialists learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a claims resolution specialist based on U.S. Bureau of Labor Statistics data and data from real claims resolution specialist resumes.

Research claims resolution specialist duties and responsibilities

Manage expedition of appeals via problem solving and collaboration with other departments.
Assist provider with ICD-9, CPT and revenue codes, DME, coordination of benefits, efficiently train on HIPPA.
Process medical claims submit to Kansas Medicaid using establish guidelines and policies.
Ensure compliance with HIPAA regulations and requirements.

Get claims resolution specialist experience

Generally, it takes 6-12 months to become a claims resolution specialist. The most common roles before becoming a claims resolution specialist include customer service representative, claim processor team lead and claims representative.

Prepare your claims resolution specialist resume

When your background is strong enough, you can start writing your claims resolution specialist resume.

You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a claims resolution specialist resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose from 10+ customizable claims resolution specialist resume templates

Build a professional claims resolution specialist resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your claims resolution specialist resume.