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.
Resolution specialist responsibilities
Here are examples of responsibilities from real resolution specialist resumes:
- 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.
- Focuse on proficiency following Medicaid guidelines.
- Gain higher level of communication and negotiation skills to prevent and reduce delinquency.
- Ensure compliance with applicable legal and regulatory requirements including HIPAA and other state and/or regional requirements.
- Adhere to company policies and procedures including all HIPAA guidelines/regulations and insurance fraud and abuse guidelines.
- Interact with medical, pharmaceutical personnel and patients to research medication coverage and complete prior authorization requests.
- Utilize excellent communication and negotiation skills to resolve credit card delinquency favorable to company and card member.
- Deliver effective financial solutions relate to billing matters for patients in community, rural and critical access hospitals.
- Answer cancellation/supervisor calls for the DirecTV project.
- Provide technical support to DirecTV customers
Resolution specialist skills and personality traits
We calculated that 15% of Resolution Specialists are proficient in Patients, Phone Calls, and Appeals. They’re also known for soft skills such as Communication skills, Computer skills, and Customer-service skills.
We break down the percentage of Resolution Specialists that have these skills listed on their resume here:
- Patients, 15%
Assisted uninsured hospital patients with Medicaid applications by gathering required documents and information and submitting to County Assistance Office.
- Phone Calls, 7%
Field escalated telephone calls in a supervisory capacity from Customer Service and Resolution Department representatives.
- Appeals, 6%
Collaborated with clinical pharmacists and administrative benefits specialists to research, review and process clinical and administrative appeals respectively.
- CPT, 5%
Provided response to inquiry on medical billing, medical authorizations, and CPT codes for doctor offices and hospitals personnel.
- Inbound Calls, 4%
Provide real-time support to representatives taking inbound calls from internet and telephone service subscribers.
- PowerPoint, 4%
Created MS PowerPoint training material to standardize program documentation and clerical procedures.
Most resolution specialists use their skills in "patients," "phone calls," and "appeals" to do their jobs. You can find more detail on essential resolution specialist responsibilities here:
Communication skills. One of the key soft skills for a resolution specialist to have is communication skills. You can see how this relates to what resolution specialists do because "customer service representatives must be able to provide clear information in writing, by phone, or in person." Additionally, a resolution specialist resume shows how resolution specialists use communication skills: "negotiated payment arrangements and resolved customer disputes using strong communication, assertiveness and customer services skills. "
Customer-service skills. This is an important skill for resolution specialists to perform their duties. For an example of how resolution specialist responsibilities depend on this skill, consider that "representatives help companies retain customers by professionally answering questions and helping to resolve complaints." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a resolution specialist: "provided excellent customer service to customers regarding medical insurance claims. ".
Interpersonal skills. resolution specialist responsibilities often require "interpersonal skills." The duties that rely on this skill are shown by the fact that "representatives should be able to create positive interactions with customers." This resume example shows what resolution specialists do with interpersonal skills on a typical day: "provided excellent customer service by using communication and interpersonal skills to anticipate and fulfill customer s requests and expectations. "
Patience. A commonly-found skill in resolution specialist job descriptions, "patience" is essential to what resolution specialists do. Resolution specialist responsibilities rely on this skill because "representatives should be patient and polite, especially when interacting with dissatisfied customers." You can also see how resolution specialist duties rely on patience in this resume example: "provide assistance to front line staff with escalated customer calls while exercising professionalism, patience and diplomacy at all times. "
Problem-solving skills. Lastly, "problem-solving skills" is an important element of what a resolution specialist does. Resolution specialist responsibilities require this skill because "representatives must determine solutions to customers’ problems." This resume example highlights how resolution specialist duties rely on this skill: "assist in explaining and locating explanation of benefits (eob's) delivering first call resolution on all matters to providers. "
The three companies that hire the most resolution specialists are:
- Change Healthcare44 resolution specialists jobs
- Bank of America34 resolution specialists jobs
- Trinity Health21 resolution specialists jobs
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Compare different resolution specialists
Resolution specialist vs. Customer care specialist
A customer care specialist is responsible for assisting the customers with their inquiries and concerns regarding the goods and services offered by the organization. A customer care specialist must be detail-oriented, as well as have excellent communication and time-management skills in responding to the customers' needs while documenting the processes on a specific computer program. Customer care specialists are responsible for processing payments, replacing defective items, and initiating refunds as needed. They must resolve complaints accurately and efficiently to ensure customer satisfaction to keep a good reputation for the organization.
There are some key differences in the responsibilities of each position. For example, resolution specialist responsibilities require skills like "patients," "phone calls," "appeals," and "cpt." Meanwhile a typical customer care specialist has skills in areas such as "customer service," "data entry," "inbound phone calls," and "customer support." This difference in skills reveals the differences in what each career does.
Customer care specialists earn the highest salaries when working in the insurance industry, with an average yearly salary of $34,400. On the other hand, resolution specialists are paid more in the finance industry with an average salary of $44,697.customer care specialists tend to reach similar levels of education than resolution specialists. In fact, customer care specialists are 1.5% less likely to graduate with a Master's Degree and 0.8% less likely to have a Doctoral Degree.Resolution specialist vs. Account services specialist
An account services specialist manages the customer accounts and ensures that it performs well and generates income and profit. The account services specialist processes and records all financial transactions and also provides auditing and quality assurance services. It is the account services specialist's job to maintain healthy communication with the client and guide them through all the processes that make the account productive. The account services specialist also needs good conversational skills with people and has a high organizational ability.
Each career also uses different skills, according to real resolution specialist resumes. While resolution specialist responsibilities can utilize skills like "phone calls," "appeals," "cpt," and "problem resolution," account services specialists use skills like "strong customer service," "client facing," "account management," and "past due accounts."
Account services specialists may earn a lower salary than resolution specialists, but account services specialists earn the most pay in the insurance industry with an average salary of $39,751. On the other hand, resolution specialists receive higher pay in the finance industry, where they earn an average salary of $44,697.In general, account services specialists achieve similar levels of education than resolution specialists. They're 0.1% less likely to obtain a Master's Degree while being 0.8% less likely to earn a Doctoral Degree.What technology do you think will become more important and prevalent for resolution specialists in the next 3-5 years?
Natalie Mayko
Special Education Inclusion Teacher, Holyoke High School
Resolution specialist vs. Customer service specialist
Customer service specialists are employees who are responsible for providing the best customer experience to customers, usually for after-sales transactions. They attend to customers' inquiries and provide answers to their questions on products or services that the company offers. They also address customer complaints and help mitigate the concerns by offering solutions such as instructions on how to fix defects, or processing replacements or refunds. Customer service specialists also listen to customer feedback and ensure that these are logged properly so that proper departments will be able to receive them.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a resolution specialist is likely to be skilled in "patients," "phone calls," "appeals," and "cpt," while a typical customer service specialist is skilled in "customer service," "strong customer service," "cleanliness," and "front end."
Customer service specialists make a very good living in the finance industry with an average annual salary of $34,860. On the other hand, resolution specialists are paid the highest salary in the finance industry, with average annual pay of $44,697.customer service specialists typically earn similar educational levels compared to resolution specialists. Specifically, they're 1.6% less likely to graduate with a Master's Degree, and 0.8% less likely to earn a Doctoral Degree.Resolution specialist vs. Customer support specialist
A customer support specialist is responsible for assisting a customer's inquiries and concerns regarding the goods and services the organization offers. Customer support specialists handle customer issues and resolve them promptly, escalating high-level complaints to the immediate supervisors. A support specialist will also replace products or process payment refunds as needed. Their goal is to maintain the highest customer satisfaction and keep a good reputation for the company while driving revenues and increasing profitability. A customer support specialist must have outstanding communication skills, as well as the ability to multi-task to record customer complaint cases while providing resolution.
Updated January 8, 2025
