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Claims Research Associate Jobs (NOW HIRING)

Health Advocate, Inc.

Claims Associate

$18.25 - $24.50/hr

Research billing issues to determine the possible cause of the error and assist with claims ... Associate degree from an accredited college or university with major course work in business ...

Health Advocate Solutions

Claims Associate

$18.25 - $24.50/hr

Research billing issues to determine the possible cause of the error and assist with claims ... Associate degree from an accredited college or university with major course work in business ...

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How much do claims research associate jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for claims research associate in the United States is $20.99, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $23.08 per hour, depending on experience, location, and employer.

What is a claims research associate?

Claims Research Associates are professionals who investigate and analyze insurance claims to determine their validity and ensure they comply with policy terms. They gather and review documentation, interview relevant parties, and communicate findings to claims adjusters or insurance companies. Their work helps prevent fraud and ensures that clients receive fair compensation. Claims Research Associates often work in insurance companies, healthcare organizations, or third-party administrators.

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

To thrive as a Claims Research Associate, you need strong analytical abilities, attention to detail, and a background in insurance, finance, or a related field—often supported by a relevant degree or experience. Familiarity with claims management software, databases, and Microsoft Office Suite is typically required, and some positions may value industry certifications like AIC (Associate in Claims). Excellent communication, problem-solving skills, and the ability to manage time effectively help set top performers apart. These skills ensure accurate investigation and resolution of claims, which is essential for minimizing risk and providing excellent customer service.

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

Claims Research Associates often encounter challenges such as analyzing incomplete or ambiguous claim information, managing a high volume of cases, and coordinating with multiple departments to resolve discrepancies. Successfully managing these challenges requires strong attention to detail, effective organizational skills, and clear communication with both internal teams and external parties. Utilizing available claims management systems and regularly collaborating with colleagues can help streamline processes and ensure accurate claim resolution.

What is the difference between Claims Research Associate vs Claims Adjuster?

AspectClaims Research AssociateClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may prefer associate degreesHigh school diploma or equivalent; licensing may be required depending on state
Work EnvironmentOffice setting, research-focused tasksField and office settings, investigating claims
Industry UsageInsurance companies, third-party administratorsInsurance companies, public agencies
Common Search/ComparisonClaims Research Associate vs Claims Adjuster

The main difference between a Claims Research Associate and a Claims Adjuster lies in their roles. Claims Research Associates primarily focus on gathering and analyzing information related to insurance claims, often working in an office environment. Claims Adjusters, on the other hand, investigate claims directly, sometimes in the field, and make decisions on claim validity and settlement. Both roles require knowledge of insurance policies, but Claims Adjusters typically need licensing, whereas Claims Research Associates focus more on research skills.

How can I become a claims research associate?

To become a claims research associate, candidates typically need a high school diploma or equivalent, with some roles preferring a bachelor's degree in fields like insurance, business, or related areas. Relevant skills include attention to detail, analytical thinking, and proficiency with data management tools. Gaining experience through internships or entry-level positions in insurance or claims processing can also improve job prospects.

Is claims research a stressful job?

Claims research as a Claims Research Associate involves analyzing insurance claims, which can be demanding due to tight deadlines and the need for accuracy. The job may involve repetitive tasks and detailed data review, but stress levels vary depending on workload, company environment, and individual coping skills.

What cities are hiring for Claims Research Associate jobs?

Cities with the most Claims Research Associate job openings:

What states have the most Claims Research Associate jobs?

States with the most job openings for Claims Research Associate jobs include:

Claims Research Associate jobs near you

Claims Research Specialist

SOUTHEASTERN RETINA ASSOCIATES PC

Knoxville, TN • On-site

Full-time

Re-posted yesterday

Job description

About Us:

Southeastern Retina Associates (SERA), with 21 board-certified ophthalmologists specializing in the treatment and surgery for diseases of the retina, macula and vitreous, is one of the largest remaining physician-owned and independent retina practices in the country, and the most experienced retina team in East Tennessee. Since 1980, SERA has offered the most advanced surgical, injection and medical approaches to patients with all types of retinal conditions, including age-related macular degeneration (AMD), retinal detachment, diabetic retinopathy, macular diseases, retinal vascular diseases, ocular tumors, and ocular trauma. Our compassionate retina specialists combine cutting-edge science with a patient-centric philosophy to achieve the best possible outcomes.


POSITION SUMMARY

Assist with the revenue cycle management of SERA’s Billing Department with a primary focus on the resolution of error, rejected and delinquent claims. This includes, but is not limited to: reviewing claims, researching identified errors, compiling required documentation and preparing the appropriate correspondence to ensure payment.

ESSENTIAL FUNCTIONS
  • Maintain delinquent claims worklist queue and coordinate with fellow Claims Research Specialist.
  • Review and research delinquent claims and take all necessary actions and/or corrections to ensure claims payment.
  • Processing paper claims and electronically submitted claims including providing additional documentation as required by Carrier to ensure proper payment (Workman’s Compensation, skilled nursing facilities, etc.).
  • Electronic data input of secondary claims for carriers requiring on-line claim submission.
  • Answer incoming calls from patients, front desk staff and clinical staff as needed helping provide resolutions to current issues.
KNOWLEDGE/SKILLS/ABILITIES:
  • Requires in depth understanding of medical reimbursement and coding, including Medicare and Third-Party Insurance guidelines, with the ability to apply knowledge to daily responsibilities.
  • Thorough understanding of medical billing, collections and payment posting, revenue cycle, third party payers, Medicare; strong knowledge of TN, GA, VA and Federal payer regulations.
  • Working knowledge of CPT and ICD10 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
  • Knowledge of business management and basic accounting principles to promote effective communication between Billing and Accounting.
  • effective relationships with patients, physicians, staff and other people contacted in the course of the work.
  • Proven records of attention to detail and commitment to accuracy in work performed including the ability to enter data accurately in end–user computer applications.

EDUCATION | EXPERIENCE

High school graduate or GED Equivalent.

Minimum 2 years’ experience in a medical billing office with knowledge of medical reimbursement and coding.


PHYSICAL DEMANDS AND WORK ENVIRONMENT

The Physical Demands and Work Environment characteristics described below are critical features of this job and are representative of those that must be met by an employee to successfully perform the essential functions. They may be subject to change at any time due to reasonable accommodation or other reasons.

TYPICAL PHYSICAL DEMANDS Work may require sitting for long periods of time; also stooping, bending and stretching for files and supplies. Occasionally lifting files or paper weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard, operates a calculator, telephone, copier and other office equipment as necessary. It is necessary to view and type on computer screens for long periods.

TYPICAL WORKING CONDITIONS Work is performed in an office environment. Work involves frequent contact with staff members and physicians. Work may be stressful at times. Interaction with others is constant and interruptive. The noise level in the work environment is usually moderate. Occasional evening or weekend work as needed.

This description provides only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.

It is not intended to be all-inclusive. The employee may be required to perform other reasonably related business duties as assigned.

SERA reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment.

HIPAA: All employees are required to adhere to the SERA privacy practices as documented in the SERA Employee Handbook and all SERA HIPAA policies and procedures. Failure to comply may result in disciplinary action ranging from a warning to termination depending on the level of violation.


This is not just a job—it’s a career opportunity. We are looking for individuals who want to grow, learn, and stay. We invest in our people with structured training, support, and advancement paths. This is an ideal opportunity for someone who wants to build a future in healthcare, not just collect a paycheck.

If you’ve moved frequently between jobs or are unsure about committing to a long-term position, this may not be the right fit. But if you’re eager to join a team where you can plant roots, develop skills, and make a difference, we’d love to meet you.