What are the responsibilities and job description for the Claims Resolution Specialist position at Josselyn?
Josselyn, a nonprofit community mental health center, has been serving people since 1951 when Dr. Irene Josselyn saw a need for kids and families to get help without worrying about the cost. Today, Josselyn is known for its excellent mental health care, offering outpatient therapy, psychiatry, case management, employment support and intensive programs for youth. With 6 locations in northern Cook and Lake County, Josselyn is a high-quality affordable option serving more than 7,500 people annually. Due to our excellent programming, depth and breadth of services, financial strength, staffing and outstanding leadership, Josselyn was honored in June 2025 by being the only nonprofit named to Crain’s Chicago Business Fast 50 list for the second consecutive year.
Job Summary
Conduct follow-up with payors, vendors, and clearinghouse on open insurance claims and balances in compliance with departmental policies and procedures. Resubmit primary and secondary claims Identify potential claim issues and escalate to management. Review, identify, and resolve root causes payor denials. Ensure that claims are processed accurately to prevent financial losses for both patients and providers. Claims specialists strive for timely resolution to avoid delays in reimbursement. Complete any other projects that are assigned that has a direct impact on billing department revenue cycle.
Schedule And Compensation
Job Summary
Conduct follow-up with payors, vendors, and clearinghouse on open insurance claims and balances in compliance with departmental policies and procedures. Resubmit primary and secondary claims Identify potential claim issues and escalate to management. Review, identify, and resolve root causes payor denials. Ensure that claims are processed accurately to prevent financial losses for both patients and providers. Claims specialists strive for timely resolution to avoid delays in reimbursement. Complete any other projects that are assigned that has a direct impact on billing department revenue cycle.
Schedule And Compensation
- Monday - Friday 8:30 AM - 4:30 PM (please note, this position requires weekly in office workdays)
- $22 - $25 hourly based on experience
- Researching claim denials
- Submitting appeals
- Following up on outstanding claims
- Handling claims correspondence
- Reviewing and processing insurance claims in a timely and accurate manner
- Investigating and resolving complex claim issues
- Maintaining detailed records of all claims activity
- Communicating regularly with policyholders, claimants, and insurance carriers
- Medical Terminology: A solid understanding of medical vocabulary is crucial for interpreting diagnoses, procedures, and coding accurately.
- Insurance Claims: Proficiency in handling Commercial insurance claims, including reviewing, processing, and understanding policy coverage.
- Data Entry: Accurate and efficient data entry skills are essential for managing claims information.
- Patient Accounts: Familiarity with managing patient accounts, coordinating payment arrangements, and updating insurance details.
- Medicaid Knowledge: Understanding Medicaid processes and requirements.
- CPT Coding: Knowledge of Current Procedural Terminology (CPT) codes used in medical billing.
- Phone Communication: Ability to make outbound calls to provider reps to effectively dispute underpaid claims.
Salary : $22 - $25
