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Claims Processor Jobs in Seattle, WA (NOW HIRING)

Progressive

Claims Adjuster Trainee

Everett, WA

$28.61 - $30.53/hr

In a fast-paced environment, you'll learn how to resolve a heavy case load of claims efficiently while managing the claims process from start to finish. You'll have the support of a collaborative ...

Geico

Principal Claims Product Tester

Seattle, WA

$100K - $157K/yr

We are seeking an experienced Principal Claims Product Tester to help modernize how we validate and ... You will play a key role in advancing our testing organization from primarily manual processes to ...

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Claims Processor information

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How much do claims processor jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for claims processor in Seattle, WA is $21.81, according to ZipRecruiter salary data. Most workers in this role earn between $18.61 and $23.51 per hour, depending on experience, location, and employer.

What is a claims processor?

A claims processor reviews insurance claims. Their responsibilities include verifying insurance policy coverage and making sure client information is accurate. After they determine there is a covered loss, a processor documents the information and makes sure all the required paperwork is complete. Other duties include modifying new or existing policies.

What does a claims processor do?

A Claims Processor is responsible for reviewing, evaluating, and processing insurance claims submitted by policyholders. They verify the accuracy of the information provided, ensure all required documentation is present, and determine if the claim meets the policy's terms and conditions. Claims Processors work with both customers and insurance adjusters to resolve any discrepancies and help facilitate timely payments. Their role is essential in ensuring that claims are handled efficiently and fairly.

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

To thrive as a Claims Processor, you need strong analytical abilities, attention to detail, and knowledge of insurance policies, typically supported by a high school diploma or associate degree. Familiarity with claims management software, data entry systems, and sometimes industry certifications like AIC (Associate in Claims) is valuable. Excellent organization, communication, and customer service skills help you efficiently resolve claims and interact with clients. These competencies ensure accuracy, minimize errors, and maintain trust in the claims process.

What are some common challenges faced by claims processors, and how can they be managed effectively?

Claims Processors often encounter challenges such as managing high volumes of claims, handling complex or incomplete documentation, and meeting strict accuracy and timeliness standards. To navigate these, strong organizational skills, effective communication with colleagues and claimants, and attention to detail are crucial. Utilizing workflow management tools and maintaining open channels with supervisors and other departments can help address issues quickly and ensure claims are processed efficiently. Regular training and staying updated on policy changes also support success in this role.

What is the difference between Claims Processor vs Claims Examiner?

AspectClaims ProcessorClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require certificationHigh school diploma; certification often preferred
Work EnvironmentOffice setting, processing claims efficientlyOffice setting, reviewing and approving claims
Employer & Industry UsageInsurance companies, healthcare providersInsurance companies, government agencies
Common Search & ComparisonClaims Processor vs Claims Examiner

Claims Processors primarily handle the data entry and initial processing of insurance claims, focusing on accuracy and efficiency. Claims Examiners review claims for validity, compliance, and coverage before approval. While both roles work within the insurance industry and require similar credentials, Claims Examiners typically perform more detailed reviews and decision-making tasks. Understanding these differences helps job seekers identify the right role based on their skills and career goals.

Do you need a degree to be a claims processor?

A degree is not typically required to become a claims processor, as most employers prioritize relevant skills such as attention to detail, communication, and familiarity with claims processing software. Many positions accept candidates with a high school diploma or equivalent, and on-the-job training is often provided. Certifications in claims or insurance can enhance job prospects but are not mandatory.

Is claims processing a stressful job?

Claims processing is often considered a routine administrative role that requires attention to detail and organizational skills. While it can involve handling high volumes of claims and meeting deadlines, stress levels vary depending on workload, workplace environment, and individual resilience. Proper training and time management can help mitigate stress in this job.
More about Claims Processor jobs

What are the most commonly searched types of Claims Processor jobs in Seattle, WA?

The most popular types of Claims Processor jobs in Seattle, WA are:

What are popular job titles related to Claims Processor jobs in Seattle, WA?

For Claims Processor jobs in Seattle, WA, the most frequently searched job titles are:

What job categories do people searching Claims Processor jobs in Seattle, WA look for?

The top searched job categories for Claims Processor jobs in Seattle, WA are:

What cities near Seattle, WA are hiring for Claims Processor jobs?

Cities near Seattle, WA with the most Claims Processor job openings:

Claims Processor jobs near you
Infographic showing various Claims Processor job openings in Seattle, WA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $45,366 per year, or $21.8 per hour.

Amwins A&H- Claims Manager, Stop Loss

Amwins

Seattle, WA • On-site

Full-time

Re-posted 6 days ago

Amwins rating

7.8

Company rating: 7.8 out of 10

Based on 38 frontline employees who took The Breakroom Quiz

193rd of 309 rated insurance

Job description

Manager, Stop Loss Claims
(Remote)
Amwins Accident & Health Underwriters, formerly known as Beacon Risk Strategies, is conducting a search looking for an experienced Manager, Stop loss Claims.
Amwins Accident & Health (Amwins A&H) has primary locations in Seattle, WA and Atlanta, GA, and is a managing underwriter for several key carrier partners. We provide a unique approach to even the most challenging risk. Expertise includes Medical Stop Loss, Hospital Indemnity Plans, and other niche A&H products.
As a specialty underwriter, distributor, and program manager, Amwins A&H focuses on medical stop-loss and other accident and health products. Brokers, TPAs and reinsurers rely on the higher standard set by Amwins A&H in everything we do - from our thoughtful approach to underwriting to our tenacious focus on delivering superior cost containment, claims administration and customer service. Our employees pride themselves on prompt, personalized service and our customers have direct access to the claims and underwriting teams. Please visit www.amwins.com/opco/amwins-accident-health-underwriters
Amwins A&H is an Amwins Group Inc. company (www.amwins.com). Amwins is the largest wholesale brokerage and group insurance administrator in the US; we are privately held with annual placed premiums over $45b, over 165+ locations around the world, 60 operating companies and employs over 8.1k people.
Amwins has expertise across a diversified mix of property, casualty, and group benefits products, and offers value-added services to support some of these products, including product development, underwriting, premium and claims administration and actuarial services.
Position Overview
The Manager, Stop Loss Claims, will play a critical role in supporting the A&H claims organization by performing claims adjudication functions, managing complex, high-dollar and high-ambiguity stop loss claims, employing cost containment solutions, serving as a senior escalation point, and applying expert judgment to drive consistent, high-quality outcomes.
This role will be responsible for some personal claims production including, but not limited to, high dollar and complex stop loss claim reimbursement requests and will assist with overall claims department operations. It is designed to complement current claims leadership by adding depth of expertise, decision-making capacity, and mentorship through influence and credibility.
The successful candidate will bring deep stop loss claims experience, strong financial and contractual acumen, and the ability to operate effectively in gray areas where precedent, documentation, and interpretation require seasoned judgment.
Responsibilities
Stop Loss Claims Oversight
  • Serve as a senior escalation point for complex, high-dollar, or high-risk stop loss claims.
  • Review and evaluate claims requiring eligibility or medical necessity review, advanced contractual interpretation, medical judgment, or financial analysis.
  • Apply expert judgment to claim decisions that materially impact financial outcomes.
  • Identify trends, risks, and opportunities related to claim determinations and outcomes.
  • Support loss mitigation and cost containment through industry knowledge and expertise.
  • Participate in daily claim processing, escalated claim reviews and decision making.
  • Perform monthly and year-end aggregate claim reporting audits and review prior to referral to senior management.
  • Partner with internal teams to ensure consistent application of stop loss provisions and claims philosophy.

Collaboration & Influence
  • Work closely with existing management, claims leadership, underwriting, and operations teams.
  • Provide insight and recommendations on claims-related matters that influence pricing, program structure, and risk assessment.
  • Function as a trusted internal resource for complex claims discussions and decision-making.
  • Assist underwriting department in setting reserves for ongoing claimants.

Mentorship & Knowledge Sharing
  • Mentor and coach claims professionals through guidance, case review, and knowledge sharing.
  • Contribute to the development of training content or informal learning sessions as appropriate.
  • Elevate claims capability across the organization by sharing best practices and technical expertise.

Vendor & Partner Interaction
  • Engage with TPAs, carriers, and external partners on complex claims matters as needed.
  • Help manage, interpret and escalate reporting from TPA partners as needed.
  • Support alignment between internal claims philosophy and external partner execution.
  • Stay abreast of industry changes as related to emerging medical and pharmacy trends as well as cost containment solutions.

Qualifications
  • Bachelor's degree or equivalent experience required.
  • 10+ years of hands-on medical stop loss claims experience, including responsibility for complex, high-dollar, and high-ambiguity claims and understanding of self-funded claim funding processes.
  • Expert level understanding of physician and hospital billing practices, medical terminology, case management and utilization review reporting and industry claim processing best practices.
  • Demonstrated expertise interpreting stop loss contracts, plan documents, and policy language, including exclusions, limitations, aggregating specifics, lasers, and reimbursement thresholds.
  • Strong understanding of medical claims adjudication, including eligibility, coordination of benefits, medical necessity considerations, and primary drivers of large claims.
  • Proven ability to apply sound, defensible judgment in non-standard claims scenarios where documentation is incomplete, facts are disputed, or precedent is unclear.
  • Experience evaluating the financial impact of claims decisions, balancing contractual compliance, reimbursement outcomes, and long-term program integrity.
  • History of working with multiple TPA claim administrators and demonstrated ability to understand different claim reporting templates and to identify gaps in reports across partners.
  • Track record of serving as an escalation resource for complex claims issues, providing clear, well-reasoned recommendations to internal stakeholders.
  • Ability to collaborate effectively across functional departments including claims, underwriting, finance, legal, and operations without formal authority.
  • Experience mentoring or guiding other claims professionals through case review, technical coaching, or knowledge sharing.
  • Strong written and verbal communication skills, with the ability to clearly explain complex claims determinations to varied audiences.
  • Experience with Connexure, ESL Office software.

Core Competencies
  • Stop Loss Claims Judgment
    Applies consistent, defensible judgment in complex and high dollar stop loss claims through accurate interpretation of contract language, plan provisions, and medical documentation.
  • Technical Contract InterpretationDemonstrates deep expertise in stop loss contracts and plan documents, including exclusions, limitations, aggregating specifics, lasers, and reimbursement thresholds.
  • Financial Impact Evaluation
    Assesses the financial implications of claims decisions, balancing contractual compliance, reimbursement outcomes, and long-term program integrity.
  • Escalation & Decision Ownership
    Serves as a senior escalation point for ambiguous or disputed claims, providing clear recommendations and owning decisions through resolution.
  • Comfort with AmbiguityOperates effectively in non-standard claims scenarios where facts, documentation, or precedent are incomplete or conflicting.
  • Influence Through Expertise
    Elevates claims quality and consistency through technical credibility, mentorship, and collaboration rather than positional authority.

Pursuant to Washington regulation, the compensation range for this position is as stated and includes eligibility for performance-based bonuses.
Washington Pay Range
$140,000-$155,000 USD

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