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Claims resolution specialist vs resolution specialist

The differences between claims resolution specialists and resolution specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 6-12 months to become both a claims resolution specialist and a resolution specialist. Additionally, a resolution specialist has an average salary of $38,984, which is higher than the $38,432 average annual salary of a claims resolution specialist.

The top three skills for a claims resolution specialist include patients, medical terminology and insurance claims. The most important skills for a resolution specialist are patients, phone calls, and appeals.

Claims resolution specialist vs resolution specialist overview

Claims Resolution SpecialistResolution Specialist
Yearly salary$38,432$38,984
Hourly rate$18.48$18.74
Growth rate-4%-4%
Number of jobs55,413152,590
Job satisfaction--
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 45%
Average age4040
Years of experience1212

What does a claims resolution specialist do?

Claims resolution specialists are in charge of outstanding claims follow-ups, submitting appeals, and corresponding to work claims. To be good at this job, they find different techniques to resolve outstanding patient claims. When performing their duties, these specialists make sure that they work with professionalism and high detail quality. They should be comfortable with navigating computerized claims and various platforms while assisting their clients over the phone. These types of specialists also always maintain the confidentiality of their members' data.

What does a resolution specialist do?

A Resolution Specialist is responsible for investigating claims and analyzing supporting documents to resolve complaints. Resolution Specialists may work for clients' disputes or employee relations, requiring them to have extensive knowledge of labor laws and regulatory policies. They conduct cross-examinations, administer negotiations, and discuss processes with the clients for high-level violations. A Resolution Specialist must have excellent communication and organizational skills, especially in representing the client and the company and coming up with the resolution that would work for both's best interests.

Claims resolution specialist vs resolution specialist salary

Claims resolution specialists and resolution specialists have different pay scales, as shown below.

Claims Resolution SpecialistResolution Specialist
Average salary$38,432$38,984
Salary rangeBetween $30,000 And $47,000Between $26,000 And $57,000
Highest paying City-Ewing, NJ
Highest paying state-Connecticut
Best paying company-IBM
Best paying industry-Finance

Differences between claims resolution specialist and resolution specialist education

There are a few differences between a claims resolution specialist and a resolution specialist in terms of educational background:

Claims Resolution SpecialistResolution Specialist
Most common degreeBachelor's Degree, 52%Bachelor's Degree, 45%
Most common majorBusinessBusiness
Most common college--

Claims resolution specialist vs resolution specialist demographics

Here are the differences between claims resolution specialists' and resolution specialists' demographics:

Claims Resolution SpecialistResolution Specialist
Average age4040
Gender ratioMale, 26.0% Female, 74.0%Male, 36.8% Female, 63.2%
Race ratioBlack or African American, 11.4% Unknown, 5.1% Hispanic or Latino, 20.6% Asian, 6.2% White, 56.0% American Indian and Alaska Native, 0.6%Black or African American, 11.4% Unknown, 5.3% Hispanic or Latino, 19.7% Asian, 7.0% White, 55.8% American Indian and Alaska Native, 0.7%
LGBT Percentage7%7%

Differences between claims resolution specialist and resolution specialist duties and responsibilities

Claims resolution specialist example 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.
  • Determine the types of claims using submit diagnoses, CPT, and HCPS codes.
  • Communicate with claimants and insure individuals alike while ensuring privacy and HIPPA laws are maintain.
  • Show more

Resolution specialist example responsibilities.

  • Used software tools including: microsoft excel, powerpoint, outlook.
  • Provide members with accurate and appropriate information to answer questions, troubleshoot issues, and resolve member complaints.
  • Respond to service inquiries regarding existing deposit accounts, ATM and debit cards, consumer loans and eCommerce applications.
  • Contribute written materials and course content for exercises to NADL training and content to PowerPoint presentations as subject matter expert.
  • Analyze, troubleshoot, and resolve complex software, hardware, and networking issues for small and large business owners.
  • Contact federal (Medicare, TRICARE), state (Medicaid), and private health insurance companies for lien information.
  • Show more

Claims resolution specialist vs resolution specialist skills

Common claims resolution specialist skills
  • Patients, 13%
  • Medical Terminology, 7%
  • Insurance Claims, 6%
  • Patient Accounts, 5%
  • Medicaid, 5%
  • CPT, 5%
Common resolution specialist skills
  • Patients, 15%
  • Phone Calls, 7%
  • Appeals, 6%
  • CPT, 5%
  • Inbound Calls, 4%
  • PowerPoint, 4%

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