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Claim Processing Specialist Jobs (NOW HIRING)

... 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 ...

Billing Specialist

Philadelphia, PA · On-site

$20 - $23/hr

They are seeking a Billing Specialist to join their Revenue Cycle team to support claim processing, payment posting, and denial resolution while ensuring timely and accurate reimbursement. The ...

Billing Specialist

Philadelphia, PA · On-site

$20 - $23/hr

They are seeking a Billing Specialist to join their Revenue Cycle team to support claim processing, payment posting, and denial resolution while ensuring timely and accurate reimbursement. The ...

They are seeking a Billing Specialist to join their Revenue Cycle team to support claim processing, payment posting, and denial resolution while ensuring timely and accurate reimbursement. The ...

Process contracts determined by claim personnel as 'not found' in SCS system ('Not Founds') * Execute contract cancellations, mail cancellation refund checks and cancellation extract process * Assist ...

Process contracts determined by claim personnel as 'not found' in SCS system ('Not Founds') * Execute contract cancellations, mail cancellation refund checks and cancellation extract process * Assist ...

Process contracts determined by claim personnel as 'not found' in SCS system ('Not Founds') * Execute contract cancellations, mail cancellation refund checks and cancellation extract process * Assist ...

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.

Insurance Specialist Job Category: Medical Billing Full-Time Remote Middleburg Heights, OH 44130 ... Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and ...

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Claim Processing Specialist information

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$15

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How much do claim processing specialist jobs pay per hour?

As of Jul 14, 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:
Infographic showing various Claim Processing Specialist job openings in the United States as of July 2026, with employment types broken down into 81% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $39,500 per year, or $19 per hour.
Claims Processing Center Specialist

Claims Processing Center Specialist

California Correctional Health Care Services

Sacramento, CA • On-site

$4.6K - $5.7K/wk

Other

Medical, Dental, Vision, Retirement, PTO

This job post has expired today. Applications are no longer accepted.


California Conservation Corps rating

7.5

Company rating: 7.5 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

425th of 692 rated public administrative organizations


Job description


The Claims Processing Center has immediate openings for multiple Claims Processing Center Specialists at the Workers' Compensation Claims Adjuster level to work in Bill Review. This is a unique opportunity for self-motivated individuals with strong communication skills with interest in creating, scheduling, organizing, and delivering training for CPC staff. These positions may be located in one of the following locations: Fresno, Glendale, Pasadena, Pleasanton, Redding, Rohnert Park, or Vacaville.
The following is a brief outline of the duties of the Claims Processing Center Specialist as envisioned by the management team:
  • Develop content and deliver training to all levels of CPC Staff.
  • Manage special projects and perform complex duties related to the Bill Review function
  • Provide mentoring services and share acquired knowledge and skills with colleagues either through scheduled formal or informal meetings
Additionally, the successful candidate would preferably have a minimum of two years of experience within the last five years in the performance of Workers' Compensation Bill Review duties and analysis.
You will find additional information about the job in the Duty Statement .
Working Conditions
The successful candidate must reside in California upon appointment.
Selected candidate(s) hired may be required to attend in-person Onboarding at our Vacaville office with expenses for attendance paid by State Fund.
Minimum Requirements You will find the Minimum Requirements in the Class Specification.
  • WORKERS' COMPENSATION CLAIMS ADJUSTER
Additional Documents
  • Job Application Package Checklist
  • Duty Statement

Position Details Job Code #:
JC-522535
Position #(s):
402-488-9325-XXX
Working Title:
Claims Processing Center Specialist
Classification:
WORKERS' COMPENSATION CLAIMS ADJUSTER $4,470.00 - $5,078.00 A
$4,610.00 - $5,770.00 B
$6,096.00 - $7,628.00 C
New to State candidates will be hired into the minimum salary of the classification or minimum of alternate range when applicable.
# of Positions:
Multiple
Work Location:
United States
Telework:
Telework
Job Type:
Permanent, Full Time
Department Information
State Fund is California's largest provider of workers' compensation insurance. Established in 1914 by the state legislature, we offer diverse and comprehensive products and services that provide a strong and stable option for employers and injured employees with fast, reliable claims service and medical and indemnity benefits.
Our culture centers on our purpose and values. We exist to provide fairly priced workers' compensation insurance, make workplaces safe, and restore injured workers. To fully represent California, we are committed to our employees by embracing and celebrating our diverse workforce and fostering inclusion to make the workplace a dynamic environment for all. We recognize and reward high performance, yet value a healthy work/life balance.
Special Requirements Effective July 1, 2025, the State of California implemented the Personal Leave Program 2025 (PLP 2025) which reduces an employee's monthly salary in exchange for leave credits. Employees appointed to this classification will have their monthly salary reduced and will accrue hours of PLP 2025 on the first day of each pay period in accordance with the applicable bargaining contract. The salary range(s) included on this job posting do not reflect the reduction in pay.
To be considered, you must provide a fully completed STD 678 application, resume, and statement of qualifications. Alternative documents submitted in lieu of required Application, Resume, or Statement of Qualifications will not be accepted. Completed STD 678 must include duties performed, start and end dates, and hours worked per week for each position held.
Artificial intelligence (AI) tools such as ChatGPT, website searches, and third-party reviewers can be helpful in researching responses to the SOQ; however, by submitting your application for this position, you understand and acknowledge the SOQ you submit is your own work, in your own words, and accurately reflects your knowledge, skills, abilities, and experiences. Submitting an SOQ that is not your own may be cause for disqualification from the hiring process.
Application Instructions
Completed applications and all required documents must be received or postmarked by the Final Filing Date in order to be considered. Dates printed on Mobile Bar Codes, such as the Quick Response (QR) Codes available at the USPS, are not considered Postmark dates for the purpose of determining timely filing of an application.
Final Filing Date: 7/9/2026
Who May Apply
Individuals who are currently in the classification, eligible for lateral transfer, eligible for reinstatement, have list or LEAP eligibility, are in the process of obtaining list eligibility, or have SROA and/or Surplus eligibility (please attach your letter, if available). SROA and Surplus candidates are given priority; therefore, individuals with other eligibility may be considered in the event no SROA or Surplus candidates apply. Applications will be screened and only the most qualified applicants will be selected to move forward in the selection process. Applicants must meet the Minimum Qualifications stated in the Classification Specification(s).
How To Apply
Complete Application Packages (including your Examination/Employment Application (STD 678) and applicable or required documents) must be submitted to apply for this Job Posting. Application Packages may be submitted electronically through your CalCareer Account at www.CalCareers.ca.gov. When submitting your application in hard copy, a completed copy of the Application Package listing must be included. If you choose to not apply electronically, a hard copy application package may be submitted through an alternative method listed below:
Address for Mailing Application Packages
You may submit your application and any applicable or required documents to:
State Compensation Insurance Fund
Mailing Address
Attn: JC-522535 CA
PO BOX 659015
Sacramento , CA 95865
Address for Drop-Off Application Packages
You may drop off your application and any applicable or required documents at:
State Compensation Insurance Fund
Talent Acquisition/Staffing
JC-522535 CA
2275 Gateway Oaks Drive
Sacramento , CA 95833
08:00 AM - 05:00 PM
Required Application Package Documents
The following items are required to be submitted with your application. Applicants who do not submit the required items timely may not be considered for this job:
  • Current version of the State Examination/Employment Application STD Form 678 (when not applying electronically), or the Electronic State Employment Application through your Applicant Account at www.CalCareers.ca.gov. All Experience and Education relating to the Minimum Qualifications listed on the Classification Specification should be included to demonstrate how you meet the Minimum Qualifications for the position.
  • Resume is required and must be included.
  • Statement of Qualifications - A Statement of Qualifications must also be submitted according to the following theme:
    As a Bill Review trainer, what would you do to ensure staff are engaged during training sessions?
    The SOQ should be typed in Arial 10-point font and be double-spaced. Please limit the length of your SOQ to one page.
Applicants requiring reasonable accommodations for the hiring interview process must request the necessary accommodations if scheduled for a hiring interview. The request should be made at the time of contact to schedule the interview. Questions regarding reasonable accommodations may be directed to the EEO contact listed on this job posting.
Benefits State Fund employees are eligible for a number of benefits. Our benefit package includes:
Health Benefits Program (CalPERS)
Retirement (CalPERS)
Employer Health and Consolidated Benefits Contributions
Dental, Vision
401(k) and 457 Deferred Compensation Plans
Employee Assistance Program
Group Legal Services Insurance
Holidays, Vacation/Sick/Other Paid Leave
Flex Elect Reimbursement Program
Wellness and Recognition
Alternate Work Schedules
Transit Pass Program
Tuition Reimbursement
Dependent Scholarship Program
Leadership Training
Mentoring Program
https://www.statefundca.com//Home/StaticIndex?id=https://content.statefundca.com//careers/Index.asp
Contact Information
The Human Resources Contact is available to answer questions regarding the position or application process.
Human Resources Contact:
Carl Agulo
(800) 499-8668
CAgulo@scif.com
Please direct requests for Reasonable Accommodations to the interview scheduler at the time the interview is being scheduled. You may direct any additional questions regarding Reasonable Accommodations or Equal Employment Opportunity for this position(s) to the Department's EEO Office.
EEO Contact:
Rosa Gil-Robles
(800) 499-8668
California Relay Service: 1-800-735-2929 (TTY), 1-800-735-2922 (Voice) TTY is a Telecommunications Device for the Deaf, and is reachable only from phones equipped with a TTY Device.
Background Investigation
Prior to employment with State Compensation Insurance Fund, a background investigation (BI) will be initiated.
Acknowledgement
Electronic applications submitted through your CalCareer Account are highly recommended and will be received/processed faster than other methods of filing.
By applying to this position, you are also acknowledging that you have received the following information:
  • California State benefits
  • Duty statement/Job Description
  • Salary ranges and steps for the classification(s) advertised

Equal Opportunity Employer
The State of California is an equal opportunity employer to all, regardless of age, ancestry, color, disability (mental and physical), exercising the right to family care and medical leave, gender, gender expression, gender identity, genetic information, marital status, medical condition, military or veteran status, national origin, political affiliation, race, religious creed, sex (includes pregnancy, childbirth, breastfeeding and related medical conditions), and sexual orientation.
It is an objective of the State of California to achieve a drug-free work place. Any applicant for state employment will be expected to behave in accordance with this objective because the use of illegal drugs is inconsistent with the law of the State, the rules governing Civil Service, and the special trust placed in public servants.

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