Claims & Benefits Resolution Specialist

For over 16 years, Trilyon has been a leader in global workforce solutions, specializing in Cloud Technology, AI / ML, Software Development, Technical Writing, and Digital Transformation. We partner with top companies to deliver high-quality talent in engineering, IT, and emerging technologies. For additional information or to view all of our job opportunities, please visit our website https : / / trilyonservices.com / careers /

We are seeking a Claims & Benefits Resolution Specialist to join our team. This role will involve performing full-cycle claims auditing, resolving complex discrepancies, and ensuring accurate reimbursement across the claims lifecycle. The ideal candidate will have experience in claims processing, eligibility and benefits verification, authorizations, payer correspondence, and revenue cycle operations , along with a passion for improving accuracy, compliance, and billing integrity.

Job Title : Claims & Benefits Resolution Specialist

Location : West Valley City, UT (Training On-site; Hybrid / Remote with 1 required onsite day per month)

Duration : 3 Months

Rate / Salary : Competitive (Commensurate with experience and compliant with state requirements)

Job Description :

Trilyon is seeking an experienced Claims & Benefits Resolution Specialist to support end-to-end claim audits, payment accuracy checks, and corrective activities across a high-volume revenue cycle environment. The Claims & Benefits Resolution Specialist will be responsible for identifying root-cause billing issues, correcting claim errors, validating eligibility and benefits, and coordinating authorizations to ensure timely and accurate reimbursement. This is a hands-on operational role requiring someone who can independently investigate claim discrepancies and drive resolutions without extensive oversight.

The Claims & Benefits Resolution Specialist will collaborate with cross-functional teams, engage with payers, and support both onsite training and ongoing remote work requirements. The Claims & Benefits Resolution Specialist must be detail-oriented, efficient, and capable of navigating complex payer rules and reimbursement workflows.

Responsibilities :

Claims Audit & Correction

Perform detailed audits on accounts to identify billing or payment errors.

Correct claim discrepancies in alignment with organizational turnaround standards.

Ensure accuracy in claim data, coding, adjustments, and benefit alignment.

Timely & Accurate Claims Processing

Process claims quickly and accurately according to benchmarks.

Apply reimbursement rules based on benefit structures and payer requirements.

Validate supporting documentation such as eligibility, authorizations, and benefit data.

Complex Follow-Up & Dispute Resolution

Conduct follow-up on delayed, denied, or pended claims.

Investigate systemic or procedural errors and implement corrective actions.

Escalate cases to clinical review teams for medical review when necessary.

Eligibility, Benefits & Authorization Coordination

Verify eligibility, benefit coverage, and authorization requirements.

Identify inconsistencies in benefit information affecting payment outcomes.

Communicate with payers and internal departments to resolve missing or incorrect data.

Cross-Functional Collaboration

Work closely with leadership, the central business office, and clinical teams.

Participate in resolving systemic issues and trend analysis.

Support training, onboarding sessions, and onsite operational needs.

Required Skills & Experience :

2 3 years experience in revenue cycle, claims processing, eligibility / benefits, or authorizations.

Understanding of payer rules, reimbursement methods, and adjudication processes.

Experience with Epic, payer portals, or other RCM platforms.

Strong accuracy, problem-solving, and audit capabilities.

Ability to independently troubleshoot and resolve complex claim issues.

Excellent communication and comfort with hybrid / onsite work requirements.

Preferred Qualifications :

Experience in a Central Business Office or Shared Services model.

Background working with multi-state payer networks or Utah payer systems.

Work Environment :

Training : On-site in West Valley City, UT

Ongoing Work : Remote, with one mandatory onsite day per month

Schedule : Day shift, Non-Exempt

Why Join Us?

Trilyon, Inc., offers a comprehensive benefits package.

Opportunities for growth and professional development.

Collaborative and inclusive company culture.

Equal Employment Opportunity (EEO) Statement :

Trilyon, Inc., is an Equal Opportunity Employer committed to diversity, equity, and inclusion. We do not discriminate based on race, color, religion, gender, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other protected status under applicable laws. Our diverse team drives innovation, competitiveness, and creativity, enhancing our ability to effectively serve our clients and communities. This commitment to diversity makes us stronger and more adaptable.