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Claim Processing Specialist Jobs (NOW HIRING)

CVS Health

Manager, Claim Processing

New York, NY · On-site

$66K - $145K/yr

Designs quality control processes to ensure the accuracy and consistency of claim processing ... Certified Billing and Coding Specialist (CBCS) preferred. * Candidates located on the East Coast ...

BLACKBURN'S

Claims Specialist

Tarentum, PA

We are seeking a detail-oriented and motivated Claims Processing Specialist to join our growing Claims Department and help ensure timely, accurate, and compliant insurance claim processing for the ...

Integrated Resources INC

Claims analyst

Omaha, NE

... to claim processing issues. Routes and triages complex claims to Senior Claim Benefits Specialist. (*) Proofs claim or referral submission to determine, review, or apply appropriate guidelines ...

Ascent Health LLC

Data Entry Specialist

Breckenridge, CO · On-site

$24.04/hr

Position Overview The Revenue Cycle Management Specialist (RCMS) supports the financial health of the company by ensuring the fulfillment of targeted claim processing and revenue capture benchmarks.

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How much do claim processing specialist jobs pay per hour?

As of Jun 13, 2026, the average hourly pay for claim processing specialist in the United States is $18.99, according to ZipRecruiter salary data. Most workers in this role earn between $17.79 and $20.19 per hour, depending on experience, location, and employer.

What is the difference between Claim Processing Specialist vs Claims Adjuster?

AspectClaim Processing SpecialistClaims Adjuster
CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma; licensing or certification often required
Work EnvironmentOffice setting, processing claims, data entryField or office, investigating claims, assessing damages
Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusters
Primary FocusProcessing and verifying insurance claimsEvaluating damages and determining claim validity

While both roles work within the insurance industry, a Claim Processing Specialist primarily handles the administrative task of processing claims, whereas a Claims Adjuster evaluates damages and determines claim validity. The roles often overlap but differ in responsibilities and required certifications.

What does a Claim Processing Specialist do?

A Claim Processing Specialist is responsible for reviewing, evaluating, and processing insurance claims submitted by policyholders. They verify the accuracy of information, ensure all required documentation is included, and determine if the claim meets policy guidelines. Claim Processing Specialists may communicate with claimants, healthcare providers, or other relevant parties to gather additional information. Their main goal is to ensure that claims are processed efficiently, accurately, and in compliance with company and regulatory standards.

What are the key skills and qualifications needed to thrive as a Claim Processing Specialist, and why are they important?

To thrive as a Claim Processing Specialist, you need strong analytical skills, attention to detail, and a foundational understanding of insurance policies, typically supported by a high school diploma or associate degree. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Excellent organizational skills, effective communication, and customer service orientation set top performers apart. These abilities ensure accurate, timely claim assessments and foster positive client experiences, which are critical for efficient insurance operations.

What are some common challenges faced by Claim Processing Specialists, and how are they typically addressed within a team environment?

Claim Processing Specialists often encounter challenges such as high volumes of claims, tight deadlines, and complex case details that require careful review. These challenges are usually addressed through strong team collaboration, clear communication with other departments (like underwriting and customer service), and ongoing training on new policies and technology updates. Many organizations also implement workflow management tools and peer review processes to ensure accuracy and efficiency, making it easier for specialists to manage workloads and maintain high standards.
What cities are hiring for Claim Processing Specialist jobs? Cities with the most Claim Processing Specialist job openings:
What states have the most Claim Processing Specialist jobs? States with the most job openings for Claim Processing Specialist jobs include:
Claim Processing Specialist jobs near you
Manager, Claim Processing

Manager, Claim Processing

CVS Health

New York, NY • On-site

$66K - $145K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 29 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,244 frontline employees who took The Breakroom Quiz

78th of 99 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary
Manages day-to-day activities of team by providing strategic leadership and overseeing the operations of the claims processing team(s). Directs work flow to ensure the efficient and accurate processing of medical claims by establishing and monitoring productivity and quality metrics, managing and developing a team of claims support individuals, implementing process improvement initiatives, and fostering collaboration with internal and external stakeholders to optimize claim processing, minimize errors, and enhance overall operational effectiveness and customer satisfaction.

What you will do

  • Reviews claims for completeness, accuracy, and adherence to company policies and procedures, addressing any complex or escalated claims issues to provide guidance to claim processors in handling challenging cases.
  • Designs quality control processes to ensure the accuracy and consistency of claim processing, including critical follow-up procedures for effective final resolution.
  • Assists with the development of the claim processing budget by monitoring expenses, tracking budget variances, and identifying cost-saving opportunities while maintaining operational effectiveness and service quality.
  • Analyzes claim processing data and generates reports to track and evaluate key performance metrics, such as claim volume, turnaround time, accuracy rates, and productivity.
  • Collaborates with other departments, such as underwriting, legal, or customer service, to ensure effective communication and coordination in the claim processing workflow.
  • Encourages feedback from claim processors, gathers suggestions for process enhancements, and implements changes that improve efficiency, accuracy, and customer satisfaction.
  • Ensures compliance with industry regulations, company policies, and legal requirements related to claim processing and implements necessary adjustments to processes, documentation, or reporting requirements to maintain compliance.
  • Oversees ongoing training to ensure all team members are fully versed and compliant within their respective roles for claims handling and escalation.
  • Coordinates with internal and external business partners to provide leadership, functional advice, and training to staff as needed.


Required Qualifications

  • 5-7 years of experience in healthcare claims and/or operations.
  • 5-7 years of demonstrated leadership experience, including team oversight and performance management.
  • Demonstrates strong execution and delivery capabilities, including planning, implementation, and ongoing support.
  • Demonstrates strong problemsolving and sound decisionmaking capabilities in complex environments.
  • Proven ability to collaborate effectively across teams and build strong partnerships with diverse stakeholders.
  • Exhibits a growth mindset, including adaptability, continuous learning, and the ability to develop self and others.
  • Strong written and verbal communication skills.


Preferred Qualifications

  • Certified Billing and Coding Specialist (CBCS) preferred.
  • Candidates located on the East Coast preferred.

Education

  • High school diploma and/or postsecondary education or specialized training (e.g., technical or vocational programs)

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$66,330.00 - $145,860.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/15/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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