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Claim Operator Jobs in Boston, MA (NOW HIRING)

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts * 2 ... Experience in claim processing, healthcare provider information, and healthcare billing practices

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts * 2+ ... Experience in claim processing, healthcare provider information, and healthcare billing practices

Deloitte

Epic Denials Management Operator

Boston, MA · Remote

$19.50 - $26/hr

Experience analyzing billing workflows, claim issues, or operational data For individuals assigned ... Work you'll do As an Epic Denials Management Operator on the AI & Engineering team, you will be ...

Archgroup

Director, Ocean Marine Claims

Boston, MA · On-site

$131K - $177K/yr

Responsibilities Actively manage litigated and non-litigated claims consistent with Arch claim and ... P&I crew and passenger claims, Charterers Legal Liability, Marina Operators Legal Liability and P&I ...

Archgroup

Director, Ocean Marine Claims

Boston, MA · On-site

$131K - $177K/yr

Responsibilities Actively manage litigated and non-litigated claims consistent with Arch claim and ... P&I crew and passenger claims, Charterers Legal Liability, Marina Operators Legal Liability and P&I ...

Zelis

Inpatient DRG Reviewer

Boston, MA · On-site

$79K - $99K/yr

Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures * Meet and/or exceed all internal and department productivity and quality ...

Zelis

Inpatient DRG Reviewer

Boston, MA

Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures * Meet and/or exceed all internal and department productivity and quality ...

Lifeworks, Inc.

Billing Specialist (160)

Westwood, MA

$27 - $30/hr

Help develop, document, and improve standard operating procedures for billing, insurance verification, claim follow-up, denial management, and payer communication. * Provide billing-related training ...

Coverys, Inc.

Litigation Management Associate

Boston, MA · On-site

$94K - $122K/yr

Coordinate with Claim staff on questions of approval, budgeting, and case management. * Assist the ... Ability to read and interpret documents such as safety rules, operating and maintenance ...

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All JobsClaim Operator JobsClaim Operator Jobs in Boston, MA

Claim Operator information

See Boston, MA salary details

$44.5K

$82.6K

$107.6K

How much do claim operator jobs pay per year?

As of Aug 10, 2026, the average yearly pay for claim operator in Boston, MA is $82,609.00, according to ZipRecruiter salary data. Most workers in this role earn between $71,700.00 and $92,900.00 per year, depending on experience, location, and employer.

What are some common challenges a claim operator faces in managing insurance claims, and how can they be addressed?

Claim Operators often encounter challenges such as handling a high volume of claims, ensuring accuracy in documentation, and meeting strict deadlines. These challenges can be managed by developing strong organizational skills, utilizing claims management software efficiently, and maintaining clear communication with both clients and team members. Staying updated on regulatory changes and company policies also helps prevent errors and ensures compliance throughout the claims process.

What is the difference between Claim Operator vs Claims Adjuster?

AspectClaim OperatorClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance licensesHigh school diploma; licensing or certification often required
Work EnvironmentInsurance companies, claims processing centersFieldwork and office settings, inspecting damages
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Common Search & ComparisonClaim OperatorClaims Adjuster

Claim Operators primarily handle the administrative processing of claims within insurance companies, focusing on data entry and documentation. Claims Adjusters, on the other hand, evaluate damages, inspect claims, and determine settlement amounts. While both roles require insurance knowledge and sometimes licensing, Claim Operators focus on processing, whereas Claims Adjusters are more involved in assessment and decision-making.

What are the key skills and qualifications needed to thrive as a claim operator, and why are they important?

To thrive as a Claim Operator, you need strong analytical skills, attention to detail, and a foundational understanding of insurance processes, often supported by a high school diploma or equivalent. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, organization, and problem-solving abilities help in interacting with clients and resolving claims efficiently. These skills are crucial for accurately processing claims, ensuring customer satisfaction, and maintaining compliance with regulatory standards.

What does a claim operator do?

A Claim Operator is responsible for processing and managing insurance claims. They review claim submissions, verify documentation for accuracy, and determine the validity of claims according to company policies. Claim Operators may also communicate with clients, adjusters, and other stakeholders to gather additional information or resolve issues. Their role helps ensure that claims are handled efficiently and fairly, contributing to customer satisfaction and the integrity of the insurance process.
What are popular job titles related to Claim Operator jobs in Boston, MA? For Claim Operator jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Claim Operator jobs in Boston, MA look for? The top searched job categories for Claim Operator jobs in Boston, MA are:
Claim Operator jobs near you
Infographic showing various Claim Operator job openings in Boston, MA as of August 2026, with employment types broken down into 40% Full Time, 58% Part Time, 1% Contract, and 1% Nights. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $82,609 per year, or $39.7 per hour.

Clinical Claim Review RN

UnitedHealth Group

Boston, MA • Remote

Full-time

Life, Retirement

Re-posted 15 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

186th of 887 rated healthcare providers

Job description

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. 

The Program Integrity Clinical Compliance Auditor will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will utilize information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings.  The Sr. Recovery Resolution Analyst will conduct site visits and desk audits of provider claims, and medical and administrative records, to gather and analyze all necessary information to determine whether subject adhered to state and federal compliance policies, reimbursement policies, and contract compliance.  The Sr. Recovery Resolution Analyst will present and discuss audit findings with clients and input information into Optum audit workflow tools and the client's case tracking system.  Where applicable, the Auditor will support appeal and fraud investigation activities.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Review medical and administrative records for audit/compliance review
  • Travel to provider sites up to 25%/month to collect records and engage with providers
  • Present and participate in discussions with the client regarding audit observations and findings
  • Collaborate with a team of 2-5 auditors to complete reviews
  • Enter audit findings data and notes in online/electronic platform using Excel-based templates
  • Attend and participate in dispute reviews and administrative hearings
  • Demonstrated written and verbal communications skills
  • Demonstrated customer service skills

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma/GED OR equivalent work experience
  • Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts
  • 2 years of experience reviewing health care documentation in a clinical or administrative role
  • Experience with MS Office Suite, specifically Word, PowerPoint, and Excel (including familiarity with basic formulas and data analysis)
  • Ability to travel up to 25% of the time within the state of Massachusetts as business needs dictate
  • Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime
  • Must have a valid driver's license
  • Must be 18 years of age OR older

Preferred Qualifications:

  • Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health
  • Experience in claim processing, healthcare provider information, and healthcare billing practices
  • Experience working in a remote/telecommute workspace
  • Working knowledge of medical terminology and claim coding with familiarity of CPT-4, HCPCs and ICD-10 code terminology
  • Familiarity with Medicaid program and/or billing requirements

Telecommuting Requirements:

  • Reside within Massachusetts
  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
    Join a team that's committed to shaping the future of health care. Help improve life for millions as you do your life's best work

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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