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Claims Research Jobs (NOW HIRING)

WebTPA

Claims Examiner I

San Antonio, TX · On-site

This will include claims research where applicable and a range of claim complexity. What Will You Be Doing: * Day-to-day processing of claims for accounts: * Responsible for processing of claims ...

MedPOINT Management

Claims Examiner

Sherman Oaks, CA · Remote

$20 - $25/hr

Coordinate resolution of claims issues with other Departments. Assist Providers, Members and other Departments in claims research. Provide backup for other examiners within the Department. Assist in ...

Monster Energy

Claims Supervisor

Corona, CA

Research complex, high-value claims-including engineering-related issues such as packaging, downtime, quality control, and transportation-and acts as a key liaison between internal teams and external ...

Clover Health

Senior Claims Researcher

Root Cause Research: Go beyond identifying errors; perform deep-dive research into HealthEdge HRP and Source to determine if a variance was caused by configuration logic, manual intervention , or ...

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How much do claims research jobs pay per hour?

As of May 31, 2026, the average hourly pay for claims research in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Research Specialist, and why are they important?

To thrive as a Claims Research Specialist, you need strong analytical skills, attention to detail, and knowledge of insurance or claims processes, often supported by a relevant degree or experience in claims management. Familiarity with claims management software, databases, and sometimes certification such as AIC (Associate in Claims) is typically required. Excellent communication, problem-solving abilities, and customer service skills help you excel when interacting with clients and resolving complex cases. These skills ensure accurate claim resolution, compliance with regulations, and a positive experience for policyholders.

What are some common challenges faced in a Claims Research role, and how can they be managed?

A common challenge in Claims Research is navigating complex policy details and incomplete or ambiguous documentation. Researchers must often communicate with multiple stakeholders, such as policyholders, adjusters, and healthcare providers, to gather missing information and verify facts. Managing tight deadlines while ensuring accuracy is also crucial. Building strong organizational skills and maintaining clear, professional communication can help address these challenges effectively.

What are claims research professionals?

Claims research professionals are specialists who investigate and analyze insurance claims to determine their validity and ensure compliance with policy terms. They gather information, review documentation, and may interview claimants or witnesses to verify details. Their work helps insurance companies prevent fraud, process legitimate claims efficiently, and resolve disputes. Claims researchers play a crucial role in protecting both the insurer and the policyholder by ensuring fair and accurate claim settlements.

What is the difference between Claims Research vs Claims Adjuster?

AspectClaims ResearchClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma or equivalent; insurance licensing often required
Work EnvironmentOffice-based, research-focused, often involving data analysisField and office-based, investigating claims and interacting with clients
Industry UsageInsurance companies, third-party administrators, claims research firmsInsurance companies, adjusting firms, third-party administrators
Common Search & ComparisonYesYes

Claims Research involves analyzing data and gathering information to support claims decisions, often working behind the scenes. Claims Adjusters evaluate and settle claims directly with policyholders, often working in the field. While both roles require insurance knowledge and certifications, Claims Research focuses on data analysis, whereas Claims Adjusters handle claim investigations and settlements.

More about Claims Research jobs
What are the most commonly searched types of Claims Research jobs? The most popular types of Claims Research jobs are:
What job categories do people searching Claims Research jobs look for? The top searched job categories for Claims Research jobs are:
Claims Research jobs near you
Infographic showing various Claims Research job openings in the United States as of May 2026, with employment types broken down into 96% Full Time, 2% Part Time, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.
Claims Examiner I

Claims Examiner I

WebTPA

San Antonio, TX • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 6 days ago

WebTPA rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

174th of 259 rated insurance

Job description

Get To Know Us!

WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans.

Key position details: 

  • This is a Full time in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259
  • Training schedule Monday to Friday 8:00am - 4:30pm CST for 4 weeks
  • Training class start date 6/22/2026

What is your impact?
As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will include claims research where applicable and a range of claim complexity. 

What Will You Be Doing: 

  • Day-to-day processing of claims for accounts:
    • Responsible for processing of claims (medical, dental, vision, and mental health claims)
    • Claims processing and adjudication.
    • Claims research where applicable. 
    • Reviews and processes insurance to verify medical necessities and coverage under policy guidelines (clinical edit logic).
    • Incumbents are expected to meet and/or exceed qualitative and quantitative production standards.
  • Investigation and overpayment administration:
    • Facilitate claims investigation, negotiate settlements, interpret medical records, respond to Department of Insurance complaints, and authorize payment to claimants and providers.
    • Overpayment reviews and recovery of claims overpayment; corrected financial histories of patients and service providers to ensure accurate records.
    • Utilize systems to track complaints and resolutions. 
  • Other responsibilities include resolving claims appeals, researching benefits, verifying correct plan loading. 

What You Must Have: 

  • 2+ years related work experience.
  • Claims examiner/adjudication experience on a computerized claims payment system in the healthcare industry.
  • High school diploma or GED 
  • Knowledge of CPT and ICD-10 coding required. 
  • Knowledge of COBRA, HIPAA, pre-existing conditions, and coordination of benefits required. 
  • Must possess proven judgment, decision-making skills and the ability to analyze. 
  • Ability to learn quickly and multitask.
  • Proficiency in maintaining good rapport with physicians, healthcare facilities, clients and providers. 
  • Concise written and verbal communication skills required, including the ability to handle conflict. 
  • Proficiency using Microsoft Windows and Word, Excel and customized programs for medical CPT coding. 
  • Review of multiple surgical procedures and establishment of reasonable and customary fees.

What We Prefer: 

  • Some college courses in related fields are a plus.
  • Other experience in processing all types of medical claims helpful. 
  • Data entry and 10-key by touch/sight 

What We Can Offer YOU!

To support your wellbeing, comprehensive benefits are offered. As a WebTPA employee, you will have access to:

  • Medical, dental, vision, life and global travel health insurance
  • Income protection benefits: life insurance, Short- and long-term disability programs
  • Flexible schedules after training + future WAH options! 
  • Leave programs to support personal circumstances.
  • Retirement Savings Plan includes employer contribution and employer match
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available and a comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for interns and part-time employees may differ.

General Physical Demands:  Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. 


Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. 
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

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