Claims Resolution ManagerUpward Health • Islip Terrace, New York, US
Claims Resolution Manager
Upward Health • Islip Terrace, New York, US
job_description.job_card.variable_hours_ago
serp_jobs.job_preview.job_type
- serp_jobs.job_card.permanent
job_description.job_card.job_descriptionAnalyze payer trends to identify root causes of denials and implement proactive corrective actions. Oversee appeals, resubmissions, and secondary claims to maximize recoveries. Process & Performance Management Develop standardized workflows and best practices to drive efficiency and accuracy. Partner with Revenue Cycle, Coding, and Clinical Operations teams to prevent rework and reduce avoidable denials. Compliance & Payer Relations Serve as the escalation point for payer disputes and foster strong relationships with payers to facilitate timely resolution. Leadership & Collaboration Collaborate with Finance, Technology, and Market Operations to support company-wide revenue cycle initiatives. Experience : 5+ years in medical claims resolution, revenue cycle management, or payer operations, with at least 2 years in a leadership or supervisory capacity. Knowledge : Expertise in Medicare, Medicaid, and commercial payer rules, including value-based and risk-bearing arrangements. Skills : Strong analytical and problem-solving abilities. Excellent communication and negotiation skills. Proficiency in EHR / PM and claims management systems. Preferred : Experience with Salesforce Health Cloud and Athenahealth (Athena) practice management / EHR systems. Education : Bachelors degree in healthcare administration, finance, or related field (or equivalent experience). Results-oriented with a continuous improvement mindset. Skilled at interpreting complex payer policies and regulatory guidance. Team-oriented leader who models integrity and accountability. Ability to thrive in a fast-growing, mission-driven healthcare organization. Other
Ready to apply Before you do, make sure to read all the details pertaining to this job in the description below.
Position Title : Claims Resolution Manager
Company Overview :
Upward Health is an in-home, multidisciplinary medical group providing 24 / 7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals because we know that health requires care for the whole person. Its no wonder 98% of patients report being fully satisfied with Upward Health!
Job Title & Role Description :
The Claims Resolution Manager leads the end-to-end process of resolving outstanding and denied medical claims. This role ensures timely reimbursement, compliance with payer requirements, and optimal revenue cycle performance. The ideal candidate is a problem solver who blends deep knowledge of healthcare revenue cycle operations with team-building and payer relationship skills.
Key Responsibilities :
- Claims Oversight & Resolution
Direct and manage the claims resolution team to ensure prompt follow-up on unpaid, denied, or underpaid claims.
Establish and monitor key performance indicators (KPIs) such as days in A / R, denial rate, and cash collections.
Ensure all activities comply with federal and state regulations, payer contracts, and HIPAA requirements.
Recruit, train, and mentor claims resolution staff.
Qualifications :
Advanced Microsoft Excel proficiency, including pivot tables, v-lookups, and complex formula building for data analysis and reporting.
Key Competencies :
Upward Health is proud to be an equal opportunity employer. We are committed to attracting, retaining, and maximizing the performance of a diverse and inclusive workforce. This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position.
Upward Health Benefits
Upward Health Core Values
Upward Health YouTube Channel
PIa75838ce33dd-29952-38842373
RequiredPreferredJob Industries
serp_jobs.job_alerts.create_a_job
Claim Manager • Islip Terrace, New York, US
Job_description.internal_linking.related_jobs
A company is looking for a Senior Resolution Manager to manage claims and ensure effective resolution processes.Key Responsibilities Execute decision-making to analyze claims exposure and litigat...serp_jobs.internal_linking.show_more A company is looking for a Senior Resolution Manager to manage claims and provide exceptional customer service.Key Responsibilities Execute decision-making to analyze claims exposure and litigati...serp_jobs.internal_linking.show_more A company is looking for a Manager Claims.Key Responsibilities Hire, develop, and coach employees while managing performance objectives and conducting reviews Mediate issues, manage risks, and l...serp_jobs.internal_linking.show_more A company is looking for a Corporate Insurance Claims Manager.Key Responsibilities Manage claims administration process for Property and Casualty insurance program, including incident reporting a...serp_jobs.internal_linking.show_more A company is looking for a Director, Claims Operations Optimization.Key Responsibilities Define and execute the strategy for claims operations infrastructure, including technology and process des...serp_jobs.internal_linking.show_more A company is looking for a Senior Technical Claims Specialist, Construction Complex.Key Responsibilities Determine coverage, investigate claims, assess liability, set reserves, negotiate settleme...serp_jobs.internal_linking.show_more A company is looking for a Resolution Manager to manage and resolve claims effectively.Key Responsibilities Execute decision-making to analyze claims exposure and plan appropriate resolutions In...serp_jobs.internal_linking.show_more A company is looking for a Senior Claims Examiner (Final Expense).Key Responsibilities Lead the adjudication of complex or contested life insurance claims Conduct thorough investigations of poli...serp_jobs.internal_linking.show_more A company is looking for a Supervisor, Claims Processing.Key Responsibilities Lead and manage a team to ensure performance, accuracy, and a positive customer experience Ensure compliance with op...serp_jobs.internal_linking.show_more A company is looking for a Senior Resolution Manager to manage claims and ensure effective resolution processes.Key Responsibilities Analyze claims exposure and litigation to determine appropriat...serp_jobs.internal_linking.show_more A company is looking for a Senior Claims Specialist - Employment Practice and Educator's Legal Liability.Key Responsibilities Conduct detailed analysis to investigate claims exposure and recommen...serp_jobs.internal_linking.show_more A company is looking for a Major Loss Claims Director.Key Responsibilities Manage a team of 4-8 Major Loss claim adjusters and supervise complex workers compensation claims Ensure compliance wit...serp_jobs.internal_linking.show_more 
Focus on the core content of the job post, removing any extra metadata, navigation mentions, and redundant headers.Keep the formatting beautiful and high signal to noise ratio.serp_jobs.internal_linking.show_more A company is looking for a Senior Claims Specialist - Employment Practice and Educator's Legal Liability.Key Responsibilities Conduct detailed analysis of claims exposure and recommend settlement...serp_jobs.internal_linking.show_more 
You have a clear vision of where your career can go.And we have the leadership to help you get there.At CNA, we strive to create a culture in which people know they matter and are part of something...serp_jobs.internal_linking.show_more A company is looking for a Senior Manager, A&H Claims and Customer Service.Key Responsibilities Serve as a subject matter expert for travel insurance policies and train the Customer Service team ...serp_jobs.internal_linking.show_more P&C Manager, Claims Compliance.Key Responsibilities Lead and inspire claims teams to deliver exceptional service and results Oversee compliance initiatives aligned with state and federal regulat...serp_jobs.internal_linking.show_more A company is looking for a Commercial Claims Manager who will oversee the management of first party commercial property claims.
Key Responsibilities Manage day-to-day operations of the commercial ...serp_jobs.internal_linking.show_more
Claims Adjuster - Multi-State Licensed
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Claims Resolution Manager - TX FL NY HI RI Licensed
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_1_day • serp_jobs.job_card.promoted
Claims Manager
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Corporate Insurance Claims Manager
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Director of Claims Operations
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Senior Technical Claims Specialist
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Licensed Resolution Manager
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Senior Claims Examiner
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Claims Supervisor
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Claims Adjuster Manager
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Senior Claims Specialist
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Workers Compensation Claims Director
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Claim Director
Chubb • Uniondale, NY, US
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Senior Claims Adjuster
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_30 • serp_jobs.job_card.promoted
Complex Claims Consulting Director - Financial Lines D&O / E&O
CNA Insurance • Melville, NY, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Senior Manager, A&H Claims
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
P&C Claims Compliance Manager
VirtualVocations • Flushing, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted
Florida Licensed Commercial Claims Manager
VirtualVocations • Jamaica, New York, United States
serp_jobs.job_card.full_time
serp_jobs.last_updated.last_updated_variable_days • serp_jobs.job_card.promoted