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Claims Processing Specialist Jobs (NOW HIRING)

TRILLIUM HEALTH RESOURCES

Claims Specialist II

NC · Remote

$42K - $61K/yr

Claims Specialist II FLSA Status: Non-Exempt Posting Salary Range: $42,765 - $61,546 Office ... Ensure the claims system and manual processes are incorporating required actions by reviewing and ...

Wellpath

Claims Specialist (Hourly)

Franklin, TN · On-site

Overview The Claims Specialist is responsible for the accurate and timely processing of medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory ...

Wellpath

Claims Specialist (Hourly)

Franklin, TN · On-site

Overview The Claims Specialist is responsible for the accurate and timely processing of medical claims in accordance with established rules, coding standards, payer guidelines, and regulatory ...

ConnectiveRx

Claims Specialist

Pittsburgh, PA · On-site

$17 - $20.60/hr

We're not only committed to taking the pain out of the prescription process, but we're also devoted ... The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is ...

ConnectiveRx

Claims Specialist

Pittsburgh, PA · On-site

$17 - $20.60/hr

We're not only committed to taking the pain out of the prescription process, but we're also devoted ... The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is ...

ConnectiveRx

Claims Specialist

Pittsburgh, PA · On-site

$17 - $20.60/hr

We're not only committed to taking the pain out of the prescription process, but we're also devoted ... The Claims Specialist, under the direction of the Supervisor (with guidance from a Team Lead), is ...

LinQ Global

Logistics Claims Specialist

Springdale, AR · On-site

$18/hr

Logistics Claims Specialist Location: Springdale, AR 72762 Duration: 6-Month Contract (Potential ... Investigate, evaluate, and process logistics-related claims, including overages, shortages, damages ...

TRILLIUM HEALTH RESOURCES

Claims Specialist III

NC · Remote

$56K - $69K/yr

Claims Specialist III FLSA Status: Exempt Posting Salary Range: $56,270 - $69,898 Office Location ... Conduct claims research, including, but not limited to, review of claims processing system, review ...

Adecco

Claims Specialist

Temple Terrace, FL · Remote

$23/hr

If this Claims Specialist job sounds like something you would be interested in, and you meet the ... Claims processing experience Knowledge of Crypto currency and conversions Professional degree or ...

New

Trak Group

Claims Specialist

Blue Ash, OH · On-site

Claims Specialist Setting/Hours: 100% In-Office | 8-5/9-6 weekly rotation Join trak group in ... Process policy terminations and update policy administration systems with claim information.

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How much do claims processing specialist jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for claims 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 does a claims processing specialist do?

A Claims Processing Specialist is responsible for reviewing, evaluating, and processing insurance claims to determine their validity and accuracy. They verify information provided by claimants, ensure all necessary documentation is included, and follow company guidelines and regulatory requirements. Their role is crucial in ensuring that claims are processed efficiently, accurately, and in a timely manner, which helps both the insurer and the claimant. Additionally, they may communicate with policyholders, healthcare providers, or other parties to gather more information or resolve discrepancies.

What are the key skills and qualifications needed to thrive as a claims processing specialist?

A Claims Processing Specialist needs strong analytical skills, attention to detail, and knowledge of insurance policies or medical billing, often supported by a high school diploma or associate degree. Familiarity with claims management software, databases, and basic office tools is typically required, and certifications like Certified Claims Professional (CCP) can be advantageous. Excellent communication, problem-solving, and organizational skills help specialists efficiently resolve discrepancies and interact with clients or providers. These abilities are crucial to ensure accurate, timely claims processing and maintain compliance with regulatory standards.

What are some common challenges claims processing specialists face, and how can they effectively manage them?

Claims Processing Specialists often encounter challenges such as handling high volumes of claims, navigating complex policy details, and ensuring accuracy under tight deadlines. To manage these, it's important to develop strong organizational skills, pay close attention to detail, and stay current with policy updates and regulatory requirements. Leveraging available technology, communicating clearly with team members, and seeking clarification from supervisors when needed can also help maintain efficiency and reduce errors.

What is the difference between Claims Processing Specialist vs Claims Examiner?

AspectClaims Processing SpecialistClaims Examiner
CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma; insurance certifications often preferred
Work EnvironmentOffice setting, processing claims, data entryOffice setting, reviewing and evaluating claims for accuracy
Employer & IndustryInsurance companies, healthcare providersInsurance companies, third-party administrators
Search & Comparison IntentUnderstanding roles, job requirements, and career pathsEvaluating claims, assessing validity, and decision-making

While both roles involve working with insurance claims, Claims Processing Specialists focus on entering and managing claim data, whereas Claims Examiners review claims for accuracy and validity. The roles often overlap in skills and work environment, but their primary responsibilities differ, making them distinct career paths within the insurance industry.

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What states have the most Claims Processing Specialist jobs?

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Claims Processing Specialist jobs near you
Infographic showing various Claims Processing Specialist job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, 2% Contract, and 1% Nights. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $39,500 per year, or $19 per hour.

Claims Adjustments Specialist

Countryside, IL • On-site

Midwest Operating Engineers Fringe Benefit Fund
See more jobs at Midwest Operating Engineers Fringe Benefit Fundexternal

$34.89/hr

Full-time

Posted yesterday

New

Job description

Summary/Objective: 

The adjustment specialist serves as a highly analytical claims professional responsible for ensuring financial accuracy, integrity, and compliance of medical claim payments and adjustments. This position leverages claims processing technology, data analysis, reimbursement methodologies, and mathematical calculations to identify, investigate, and resolve complex claim payment discrepancies, overpayments, pricing variances, and adjustment activity. The role is responsible for maintaining accuracy across MOE, WEX, and BCBS systems, processing specialized claim transactions, managing overpayment recovery efforts, securing appropriate pricing methodologies including NSA/QPA and blue card pricing, and ensuring all claim corrections align with plan documents, benefit provisions, regulatory requirements, and current processing guidelines. This position requires advanced problem-solving skills, attention to detail, and the ability to adapt to evolving system enhancements, business processes, and industry changes while maintaining productivity and quality standards. 

Essential Functions: 

  • Maintain and monitor BCBS claim inventories, incentive reports, adjustment queues, and operational tracking reports to ensure timely processing and compliance with service standards. 
  • Process and adjust medical claims, including BlueCard, HST, WEX, transplant, NSA, out-of-network, single case agreement, and other specialized claim types in accordance with plan provisions, contractual requirements, and regulatory guidelines. 
  • Research, troubleshoot, and resolve claim processing issues, including rejected claims, system edits, mapping discrepancies, processing errors, and complex cross-system inquiries. 
  • Serve as a resource for claims examiners by identifying trends, recommending process improvements, and communicating training opportunities related to claim processing and adjustments. 
  • Manage refund, overpayment recovery, recoupment, payment correction, and stop-payment activities, including tracking, documentation, correspondence, and coordination with internal departments. 
  • Review provider late charges, corrected Medicare EOBs, special pricing requests, and high-dollar claims to ensure accurate payment determination and processing. 
  • Monitor backlog, error, reconciliation, and operational reports; analyze findings and recommend corrective actions to improve workflow efficiency and claim accuracy. 
  • Respond to inquiries and service requests within established service-level expectations. 
  • Maintain and update departmental procedures, process documentation, fraud provider listings, and other operational records to ensure compliance and consistency. 
  • Remain current on system enhancements, reimbursement methodologies, regulatory requirements, and process changes; participate in system testing and implementation activities as needed. 
  • Provide cross-functional support, process original claims during periods of increased volume, and perform other duties or special projects as assigned.

 

Education and Experience 

  • High School diploma or G.E.D. Certificate.
  • Knowledge of medical terminology, CPT codes, and ICD-10 coding is required.
  • Experience with dental claims processing 
  • Experience using Blue Cross/Blue Shield (BCBS) or subsidiary claims processing systems. 
  • Previous experience with claims adjustment processing.


Length of Experience:

  • Minimum of 2 years of claims processing experience

 

Specialized skills/technical knowledge required:

  • Strong mathematical, analytical, and problem-solving skills with the ability to accurately calculate claim payments, overpayments, recoveries, and reimbursement amount while identifying and resolving complex claim issues.
  • Working knowledge of healthcare claims processing, medical coding, and reimbursement methodologies, including CPT, ICD-10, DRG, Medicare, COB, Critical Care, NSA, and QPA pricing.
  • Ability to interpret plan documents, benefit provisions, contractual agreements, and regulatory requirements to make sound claims determinations.
  • Proficiency with claims administration systems and related technologies, including ISSI or similar platforms, BCBS applications, and workflow management tools.
  • Advanced Microsoft Excel skills for data analysis, reconciliation, reporting, and operational tracking.
  • Ability to analyze system functionality, claim processing workflows, and operational data to identify trends, improve efficiencies, and support process enhancements.
  • Strong organizational, time management, and multitasking skills with the ability to meet deadlines in a high-volume production environment.
  • Excellent written, verbal, and interpersonal communication skills, with the ability to effectively collaborate across departments and communicate complex information clearly.
  • Exceptional attention to detail, accuracy, and quality while working independently and as part of a team.
  • Ability to professionally manage sensitive payment, recovery, and provider-related issues while maintaining confidentiality and customer service standards.