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Claim Accumulator Jobs (NOW HIRING)

Collabera

Sr. Level Facets SME

Baltimore, MD · On-site

Analysis of changed benefit impact on claim adjudication, including accumulator impact and modifications required; manual accumulator changes may be required * Query support of Facets database to ...

Allied

RRT Analyst

Chicago, IL · On-site +1

$48K - $50K/yr

Work with other claim department personnel when necessary to determine appropriateness of RRT referral * RX refunds and analysis * Tracking and handling assigned projects * Accumulator updates

New

Allied Benefit Systems

RRT Analyst

$48K - $50K/yr

Work with other claim department personnel when necessary to determine appropriateness of RRT referral * RX refunds and analysis * Tracking and handling assigned projects * Accumulator updates

New

Allied Benefit Systems

RRT Analyst

Chicago, IL · Remote

Work with other claim department personnel when necessary to determine appropriateness of RRT referral * RX refunds and analysis * Tracking and handling assigned projects * Accumulator updates

New

NTT DATA Services

Accumulator Coordinator

Plano, TX · Remote

Processing of Professional claim forms files by provider Reviewing the policies and benefits Comply with company regulations regarding HIPAA, confidentiality, and PHI Abide with the timelines to ...

Premera Blue Cross

Claims Processor IV

Spokane, WA · On-site

$17.25 - $21.75/hr

... claim. * Complete accumulator adjustments, deductible credit loads, and member history reviews to identify claims to be reprocessed. * Reprocess carve-out claims, researching history and contractual ...

LucyRx

Documentation and Testing:** + Document benefit plan setup, formulary requirements, network requirements and other components of claims adjudication + Coordinate eligibility, accumulator and claim ...

Lucyrx

Implementation Manager

Coordinate eligibility, accumulator and claim file integration. * Ensure that testing and validation is completed and communicate testing results back to clients * Ensure clean handoff to operations ...

LucyRx

Implementation Manager

Coordinate eligibility, accumulator and claim file integration. * Ensure that testing and validation is completed and communicate testing results back to clients * Ensure clean handoff to operations ...

Premera Blue Cross

Claims Processor IV

$17.50 - $22/hr

... claim. * Complete accumulator adjustments, deductible credit loads, and member history reviews to identify claims to be reprocessed. * Reprocess carve-out claims, researching history and contractual ...

Premera Blue Cross

Claims Processor IV

Spokane, WA · On-site

$17.25 - $21.75/hr

... claim. * Complete accumulator adjustments, deductible credit loads, and member history reviews to identify claims to be reprocessed. * Reprocess carve-out claims, researching history and contractual ...

Premera Blue Cross

Claims Processor IV

Mountlake Terrace, WA · On-site

$18.50 - $23.25/hr

... claim. * Complete accumulator adjustments, deductible credit loads, and member history reviews to identify claims to be reprocessed. * Reprocess carve-out claims, researching history and contractual ...

VytlOne

These processes keep medical coverage eligibility, member demographics, and claim/deductible ... PBM operations Claims processing Eligibility / accumulator processing Client integrations Health ...

VytlOne

Sr. Operations Analyst

These processes keep medical coverage eligibility, member demographics, and claim/deductible ... PBM operationsClaims processingEligibility / accumulator processing Client integrationsHealth plan ...

LucyRx

Client Operations Specialist

Convert past claim files into proper format for bulk override entries * Review sample member cards ... Investigate accumulator discrepancies and escalate to confirm totals with the TPA when needed

Lucyrx

Client Operations Specialist

Convert past claim files into proper format for bulk override entries * Review sample member cards ... Investigate accumulator discrepancies and escalate to confirm totals with the TPA when needed

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How much do claim accumulator jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for claim accumulator in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.

What are popular job titles related to Claim Accumulator jobs?

For Claim Accumulator jobs, the most frequently searched job titles are:

Infographic showing various Claim Accumulator job openings in the United States as of August 2026, with employment types broken down into 81% Full Time, 17% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $43,783 per year, or $21 per hour.

Claims Operations Analyst

Montvale, NJ • On-site

EmpiRx Health, LLC
Health Care and Social Assistance • 51 - 200 employees
Learn more about EmpiRx Health, LLCexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 hours ago

Job description

Claims Operations Specialist 
 
 
EmpiRx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, EmpiRx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.  
 
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do―and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically™, EmpiRx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members. This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years. 
 
EmpiRx Health is experiencing a period of accelerated growth and platform expansion. We’re seeking a Claims Operations Specialist. The Claims Operations Specialist is responsible for managing benefit and claims issues, monitoring claims trends, and processing manual claims for direct member reimbursement and subrogation requests. This role ensures operational efficiency, data integrity, and member satisfaction by identifying trends, resolving issues, and collaborating with internal and external stakeholders to enhance claims processes.  
 
Key Responsibilities: 
  • Investigate and resolve complex claim, eligibility, and accumulator issues within service level agreements, ensuring issues are researched and documented according to departmental & enterprise standards.
  • Conduct adaptable root cause analysis to identify short-term and long-term fixes and improvements to specific or systemic problems.
  • Partner with technology, client services, customer service, finance, & privacy / legal / compliance teams to improve solution design and overall operational effectiveness.
  • Monitor claims data on an ongoing basis to identify adverse or actionable trends related to claim issues, including errors with eligibility and accumulator integration.
  • Execute the processing of direct member reimbursement requests.
  • Coordinate with relevant departments to address and process subrogation claims effectively.
  • Maintain detailed records of all manual claims processed.
  • Proactive ownership of documentation materials related to benefit plan design while ensuring accuracy and accessibility for customers and stakeholders.
Required Qualifications & Experience: 
  • 1–2 years of experience in pharmacy benefit administration, operations, or related areas.
  • Strong attention to detail, organizational skills, and ability to manage multiple priorities.
  • Bachelor’s degree or equivalent experience.
  • Demonstrated experience in issue management and problem resolution.
  • Strong analytical skills with ability to interpret data, identify trends / outliers, and diagnose potential issues.
  • Prior experience with eligibility and accumulator data.
  • Prior experience with claims adjudication platforms.
  • Familiarity with direct reimbursement processes and related systems.
  • Excellent written and verbal communication skills, with a focus on member and client satisfaction.

Preferred Qualifications: 
  • Technical proficiency and aptitude
  • Proficiency in Microsoft Office Suite, primarily Excel.
  • Experience using SQL to perform data investigation and solution design.
  • Experience with change control methodologies to aid issue resolution.
  • Experience with personalized medicine or precision-based solutions.
  • Understanding of payer, provider, or employer market dynamics.
  • Experience designing solutions for whole-person care or population health strategies.
  • Familiarity with AI/ML innovations and human-centered application in healthcare.
 
Work Environment: Fully On-Site in Orlando, FL (5 Days per Week)
 
Benefits and Perks 
Our commitment to diversity is reflected in our family and LGBTQ-friendly benefits, which include: 
  • Comprehensive medical, prescription, vision, dental, life, and disability insurance, with coverage for domestic partnerships.
  • A 401K program to secure your financial future.
  • Parental leave for childbirth and adoption.
  • Student loan reimbursement.
  • Additional perks include flexible PTO, hybrid and remote work arrangements, online wellness resources and counseling access.
 
EmpiRx Health is an Equal Opportunity Employer  
At EmpiRx Health, we wholeheartedly embrace the power of diversity and the magic of inclusion. The kaleidoscope of unique perspectives, backgrounds, and talents fuels our innovation and sets us apart. We're on a mission to build a team as diverse as the world we