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Claims Operations Associate Jobs in Philadelphia, PA

Elevance Health

Claims Auditor Lead

Wilmington, DE · Hybrid

Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 - 2days per week ... Service Operations. Responsible for pre and post payment and adjudication audits of high dollar ...

Elevance Health

Claims Auditor Lead

Wilmington, DE · Hybrid

Claims Auditor Lead Claims Auditor Lead Hybrid 1: This role requires associates to be in-office1 ... Service Operations. Responsible for pre and post payment and adjudication audits of high dollar ...

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All JobsClaims Operations Associate JobsClaims Operations Associate Jobs in Philadelphia, PA

Claims Operations Associate information

See Philadelphia, PA salary details

$13

$21

$30

How much do claims operations associate jobs pay per hour?

As of Aug 4, 2026, the average hourly pay for claims operations associate in Philadelphia, PA is $21.18, according to ZipRecruiter salary data. Most workers in this role earn between $17.21 and $23.27 per hour, depending on experience, location, and employer.

Is claims processing a stressful job?

Claims processing as a Claims Operations Associate can be stressful due to the need for accuracy, attention to detail, and meeting deadlines. The role often involves handling complex cases and working within strict regulatory guidelines, which can contribute to workplace pressure. However, stress levels vary depending on the workload, company environment, and individual coping skills.

What is the difference between Claims Operations Associate vs Claims Analyst?

AspectClaims Operations AssociateClaims Analyst
CredentialsHigh school diploma or equivalent; some roles may require relevant certificationsHigh school diploma; some roles may prefer certifications like CPCU or similar
Work EnvironmentOffice setting, handling claims processing and customer interactionsOffice or remote, analyzing claims data and making decisions
Employer & IndustryInsurance companies, third-party administratorsInsurance firms, claims departments
Search & Comparison IntentUnderstanding entry-level claims roles and responsibilitiesAnalyzing claims data and decision-making processes

The Claims Operations Associate typically handles claims processing tasks, customer service, and administrative duties within an insurance setting. In contrast, a Claims Analyst focuses more on analyzing claims data, assessing risks, and making decisions based on policy details. Both roles require knowledge of insurance policies and claims procedures, but the Claims Analyst often involves more analytical skills and data interpretation.

What is a claims operations associate?

A Claims Operations Associate is a professional who supports the processing and administration of insurance claims. They handle tasks such as reviewing claim forms, verifying information, entering data into systems, and assisting claims adjusters or examiners with documentation and communications. Their role is crucial in ensuring that claims are processed efficiently, accurately, and in compliance with company policies and regulatory requirements. Claims Operations Associates may work for insurance companies, healthcare providers, or third-party administrators.

What skills and qualifications are needed to be a claims operations associate?

To thrive as a Claims Operations Associate, you need strong analytical abilities, attention to detail, and a solid understanding of insurance processes, often supported by a bachelor's degree or relevant experience. Familiarity with claims management systems, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, organizational skills, and problem-solving abilities help you manage complex claims and collaborate effectively with internal and external stakeholders. These competencies ensure accurate, efficient claims processing and contribute to customer satisfaction and organizational compliance.

What challenges might a claims operations associate encounter in their daily work?

As a Claims Operations Associate, you may encounter challenges such as managing a high volume of claims while ensuring accuracy and compliance with regulations. Balancing timely processing with the need to investigate discrepancies or incomplete information can be demanding. Additionally, you'll often coordinate with adjusters, customers, and other departments, so strong communication and organizational skills are essential. Staying up to date with changing policies or industry standards can also be a key part of the role.
Claims Operations Associate jobs near you
Infographic showing various Claims Operations Associate job openings in Philadelphia, PA as of July 2026, with employment types broken down into 1% As Needed, 70% Full Time, 27% Part Time, 1% Temporary, and 1% Contract. Highlights an 97% Physical, 1% Hybrid, and 2% Remote job distribution, with an average salary of $44,050 per year, or $21.2 per hour.

Provider Claims Svcs Spec

Independence Blue Cross

Philadelphia, PA • On-site

Full-time

Re-posted 24 days ago

Independence Blue Cross rating

8.6

Company rating: 8.6 out of 10

Based on 25 frontline employees who took The Breakroom Quiz

89th of 301 rated insurance

Job description

Job Profile Summary
The Provider Claims Service Specialist is responsible for responding to provider inquiries and resolving issues related to claims processing, reimbursement, and pricing. This role acts as a liaison between providers and internal claims operations teams to ensure accurate, timely resolution and a high level of service in a fast-paced environment.
Key Responsibilities
  • Research and resolve provider inquiries related to claim status, pricing, reimbursement, and contract interpretation
  • Analyze claim processing issues to identify root causes and implement corrective actions
  • Collaborate with internal departments (e.g., Claims, Configuration, Network Management) to address escalated issues
  • Review and interpret provider contracts to ensure accurate claims adjudication
  • Monitor and manage assigned work queues to meet productivity and quality standards
  • Maintain detailed documentation of issue resolution and provider interactions
  • Identify trends and recommend process improvements to enhance operational efficiency and provider experience
  • Support provider education by explaining claim outcomes, policies, and procedures

Required Qualifications
  • High school diploma or equivalent required; Associate's or Bachelor's degree preferred
  • 2-4 years of healthcare claims processing or provider services experience
  • Strong knowledge of medical claims adjudication and reimbursement methodologies
  • Familiarity with provider contracts and pricing logic preferred
  • Excellent analytical, problem-solving, and communication skills
  • Ability to manage high-volume workloads and prioritize effectively
  • Proficiency in Microsoft Office (Excel, Word, Outlook) and claims processing systems

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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