Claims Resolution Specialist

Description:

The Claims Resolution Specialist is responsible for driving timely and accurate payment collection on claims—whether from insurance carriers, HOAs, or property owners. Working in parallel with or taking over from the Claims team, this role focuses on all things related to settlement, including confirming payment details, collecting funds, and managing any escalations. In addition to outbound communication, the specialist is also responsible for managing inbound communication via email and phone, ensuring a smooth experience for all parties. This role requires high attention to detail, strong communication skills, and a customer-first mindset.

Payment Collection & Communication

• Proactively contact responsible parties (carriers, HOAs, or property owners) to confirm payment details.
• Follow a structured outreach approach—from gentle follow-ups to assertive escalation—to secure payment quickly and professionally.
• In cases of denied or partially approved claims, negotiate settlements directly with property owners and, when appropriate, set up payment plans.
• Process credit card payments accurately using internal tools, ensuring compliance with company standards and security protocols.
• Collect and intake ACH information

Inbound & Outbound Communication Management

• Manage both personal email inboxes and shared team inboxes to monitor and act on incoming settlement awards and payment communications.
• Respond to inbound emails promptly and ensure clear documentation of all interactions.
• Handle inbound phone calls with professionalism
• Initiate outbound calls to clarify payment status, answer questions, and resolve open issues.

Task Management & Utilization

• Stay current on assigned tasks and close them with complete, accurate documentation.
• Maintain high utilization and efficiency by balancing communication duties with proactive task management.
• Prioritize urgent payment needs while ensuring nothing falls behind in the task queue.

Collaboration & Coordination

• Partner with Claims Advocates to gather or clarify payment-related information.
• Collaborate closely with the Accounts Receivable team on ACH processing, discrepancies, or follow-ups.
• Step in to support teammates and cover reassigned claims or absences as needed.

Professionalism & Customer Focus

• Keep the contractor’s needs front and center while maintaining a courteous, solution-oriented approach with property owners.
• Represent the company with integrity, empathy, and professionalism in every interaction.

Key Metrics for Success:

• Payment collection speed, accuracy, and documentation.
• Successful credit card and ACH processing coordination.
• Responsiveness to inbound calls and email communication.
• Task completion and utilization rate.
• Quality of outbound communication and ability to resolve payment issues.
• Team collaboration and willingness to support others.

Requirements:

Candidate Profile and capabilities:

• Eager and curious to learn new things
• Capacity to work and adapt in a growing and changing environment
• Problem solver with a high degree of perseverance and creativity to find solutions
• Self-directed with strong work ethic and ability to manage a high volume of work
• Ability to navigate conflict and de-escalate tension
• Strong negotiation capabilities a plus
• Results orientation with focus on activities that deliver outcomes and meet company, team and individual goals

Experience and qualifications:

• Bachelor’s degree preferred but Highschool Diploma or GED acceptable for candidates looking to learn about and start an exciting new career
• Call center experience not required but great to have
• Collections experience a plus