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Claim Processing Specialist Jobs (NOW HIRING)

Quadax

Insurance Specialist

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 ...

Advertising Checking Bureau

Account Specialist

Memphis, TN · On-site

$17 - $23.25/hr

The Account Specialist is responsible for providing outstanding customer service to clients by ... Proof claim documents and batches prior to release. Ensure that pended claim process follows ...

Advertising Checking Bureau

Account Specialist

Memphis, TN · On-site

$17 - $23.25/hr

The Account Specialist is responsible for providing outstanding customer service to clients by ... Assist the Supervisor in ensuring that claim processing complies with ACB and client policies ...

Addison Group

Fee Schedule Specialist

Grand Island, NY · Remote

$23 - $28/hr

Fee Schedule Specialist (Remote) Location (city, state): Remote (NYC) Industry: Managed Care ... Ensure timely and accurate claim processing. Qualifications: * Experience in medical billing.

Brightwing

Warranty Claims Specialist

Auburn Hills, MI

$23 - $24/hr

Warranty Claims Specialist Position Summary: This role is responsible for reviewing and processing ... Maintain accurate data within the SAGA system to ensure smooth claim processing and reduce ...

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Claim Processing Specialist information

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How much do claim processing specialist jobs pay per hour?

As of Aug 11, 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:
Who are the top companies hiring for Claim Processing Specialist jobs? The top employers for Claim Processing Specialist jobs are:
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
Infographic showing various Claim Processing Specialist job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 13% Part Time, 1% Temporary, 4% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $39,500 per year, or $19 per hour.

Senior Claim Benefit Specialist - Remote

CVS Health

Homer, AK • Remote

$18.50 - $42.35/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 22 days ago

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,332 frontline employees who took The Breakroom Quiz

89th of 112 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
Reviews and adjudicates complex, sensitive, and specialized medical claims in accordance with established plan processing guidelines. Functions as a subject matter expert by providing coaching, and offering guidance on escalated or technically challenging issues. Supports customer service operations by addressing inquiries and resolving issues to ensure a positive member experience.
Additional Responsibilities

- Reviews prespecified claims and those that exceed specialist adjudication authority or processing expertise.

- Applies medical necessity guidelines, determines coverage, verifies eligibility, identifies discrepancies, and implements costcontainment measures to support accurate claim adjudication.

- Ensures compliance with all regulatory requirements and confirms that payments align with company policies and procedures.

- Identifies and reports potential overpayments, underpayments, and other claim irregularities.

- Performs claim rework calculations as needed.

- Trains and mentors as needed to enhance team performance and technical proficiency.

- Conducts outbound calls to obtain required information for claims or reconsideration requests.

Required Qualifications

- Minimum of 18 months of medical claim processing experience with a health insurance payor or thirdparty administrator.

- Proven success working in a highvolume, productiondriven environment.

- Demonstrated ability to manage multiple assignments with accuracy, efficiency, and attention to detail.


Preferred Qualifications

- Self-Funding experience

- DG system knowledge


Education

- High School Diploma required

- Preferred Associates degree or equivalent work experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $42.35

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.

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.

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.

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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