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Claims Edit Jobs (NOW HIRING)

Renown Health

Revenue Integrity Specialist

Reno, NV · On-site

$82.30K - $82.80K/yr

Coding and claims edit experience required. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and ...

UPMC Health Plan

Claims Examiner

Pittsburgh, PA · On-site

The Claims Examiner will manage adjudication of standard to moderate claims while meeting or ... Batch Edit errors in accordance with designated standards. - Maintain employee/insured ...

Renown Health

Revenue Integrity Specialist

Reno, NV

$82.30K - $82.80K/yr

Coding and claims edit experience required. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and ...

Renown Health

Revenue Integrity Specialist

Reno, NV · On-site

$25.66 - $35.92/hr

Coding and claims edit experience required. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and ...

Renown Health

Revenue Integrity Specialist

Reno, NV · On-site

$82.30K - $82.80K/yr

Coding and claims edit experience required. License(s): None Certification(s): None Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, Teams, and ...

Mvphealthcare

OR

$69.38K - $92.28K/yr

Partner with engineering and product teams to develop and maintain claims edit specifications * Analyze claims data to identify trends, discrepancies, and payment process improvement opportunities

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How much do claims edit jobs pay per hour?

As of May 29, 2026, the average hourly pay for claims edit 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 is the difference between Claims Edit vs Claims Examiner?

AspectClaims EditClaims Examiner
CredentialsTypically requires insurance or claims processing certificationsRequires similar certifications, often with additional insurance licensing
Work EnvironmentPrimarily office-based, focusing on reviewing and editing claimsOffice-based, reviewing and approving insurance claims
Industry UsageCommon in insurance companies, third-party administratorsCommon in insurance carriers, government agencies
Search & Comparison IntentOften compared for claims processing rolesOften compared with Claims Edit for claims review positions

Claims Edit professionals focus on reviewing and correcting insurance claims for accuracy, while Claims Examiners evaluate and approve or deny claims based on policy coverage. Both roles require similar certifications and work environments, but Claims Examiners have a broader responsibility for decision-making in the claims process.

More about Claims Edit jobs
What cities are hiring for Claims Edit jobs? Cities with the most Claims Edit job openings:
What states have the most Claims Edit jobs? States with the most job openings for Claims Edit jobs include:
What job categories do people searching Claims Edit jobs look for? The top searched job categories for Claims Edit jobs are:
Claims Edit jobs near you
Infographic showing various Claims Edit job openings in the United States as of May 2026, with employment types broken down into 95% Full Time, and 5% Part Time. Highlights an 50% In-person, 5% Hybrid, and 45% Remote job distribution, with an average salary of $43,783 per year, or $21 per hour.
Senior Provider Network Operations Analyst

Senior Provider Network Operations Analyst

Amerihealth Caritas

Manchester, NH • Hybrid

Full-time

Posted 12 days ago

AmeriHealth Caritas rating

8.5

Company rating: 8.5 out of 10

Based on 69 frontline employees who took The Breakroom Quiz

88th of 259 rated insurance

Job description

Role Overview: The Senior Provider Network Operations Analyst responsible for maintaining current provider data and provider reimbursement setup, and to address provider and state inquiries as they relate to claim payment issues.

Work Arrangement:

  • Hybrid – The associate must be in the office at least three (3) days per week at our Manchester, New Hampshire (NH) location.

Responsibilities:

  • Review/approves and audits Payment Integrity (PI) vendor and internal prospective and retrospective edits/projects/recoveries
  • User Acceptance Testing (UAT)/Client Review & audit (provider data, Appian Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to Enterprise Operations (EO) and claims post-production
  • Facets claims edit configuration concentration (Appian) – intake, review, impact assessment, and initial submission; UAT reviews requests prior to initial submission to EO and claims post-production
  • Encounter error reconciliation representation, oversight and management – including identification and initiation of claim or provider changes necessary to mitigate/prevent future errors
  • Management and resolution of state complaints
  • State policy and contract amendment changes analysis and management
  • Internal or vendor medical policy or Health Value Optimization (HVO) edit changes and initiatives
  • Monitor and review state communications and changes, lead initial analysis/determination of action, provide direction on work request submissions to level I analysts, and test/audit subsequent changes
  • Business Process Outsourcing (BPO) and/or other intake/workflow tool management
  • Single-case agreement management/ownership, including letter development and coordination with Provider Network Management (PNM)
  • Serves as the subject matter expert in State specific health reimbursement rules and provider billing requirements and as liaison to the Enterprise Operations Configuration Department
  • Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policy and operational procedures to effectively provide technical expertise and business rules
  • Acts as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for high profile providers
  • Performs other related duties and projects as assigned

Education & Experience:

  • Associate’s degree preferred, or equivalent combination of education and experience in a healthcare field.
  • American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required.
  • 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred.
  • Strong working knowledge of Microsoft Excel, Access, Word, and other MS Office tools; ability to work with pivot charts, Access databases, and data analytics.
  • Claims processing and provider data maintenance knowledge required
  • Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required

Skills & Abilities:

  • Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts
  • Superior organizational skills required
  • Critical thinking skills
  • Strong customer service skills
  • Data and reporting analysis

What AmeriHealth Caritas employees say

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