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Claims Research Jobs (NOW HIRING)

Magellan Health, Inc.

Claims Resolution Analyst

Frisco, TX · On-site

$45K - $68K/yr

The Claims Internal Resolution Analyst is responsible for coordinating the resolution of claims issues locally at the health plan by actively researching and analyzing systems and processes that span ...

Integrated Resources INC

Claims Analyst I

Syracuse, NY · On-site

Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Title : Claims Analyst I Location : Syracuse, NY Duration : 3+ Months (Possible extension) Responsibilities : Mon ...

NorthBay Health

Claims Analyst II (On-Site)

Fairfield, CA · On-site

$33.29 - $40.44/hr

Performs special claims research projects as assigned. Hours of Work : Full-time, non-exempt. Qualifications REQUIRED: * Associate's degree required or minimum 4 years of health care claims ...

Kalogon, Inc.

Research Lead

Melbourne, FL

Conduct user research, beta testing, and claims research * Socialize research findings and ensure team members can self-support by creating tools to access your research * Write, field, and analyze ...

Afni, Inc.

Virtual Subrogation Specialist

$21/hr

Research laws and state statutes on subrogation claims to ensure compliance and optimize recovery. * Communicate effectively to obtain and provide necessary information from relevant parties.

Afni, Inc.

Virtual Subrogation Specialist

IL · On-site +1

$21/hr

Research laws and state statutes on subrogation claims to ensure compliance and optimize recovery. * Communicate effectively to obtain and provide necessary information from relevant parties.

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How much do claims research jobs pay per hour?

As of Jul 6, 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 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.

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 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 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.
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
Claims Resolution Representative Hybrid Warwick, RI

Claims Resolution Representative Hybrid Warwick, RI

Gainwell Technologies

Warwick, RI • On-site

$30K - $43K/yr

Other

Medical, Life, Retirement, PTO

Posted 10 days ago

Gainwell Technologies rating

7.7

Company rating: 7.7 out of 10

Based on 72 frontline employees who took The Breakroom Quiz

115th of 202 rated software companies

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
Perform routine but moderately complex tasks that are related to healthcare policy and claims processing including prior authorizations, third-party liability, and manual pricing. Apply knowledge of established procedures and policy to research and resolve customer questions or management requests utilizing policy manuals. Ensure that claims are processed according to state and federal regulations while meeting contractual obligations. Resolve most problems and escalates only the most complex issues to immediate supervisor. Examples of work performed may include preparing correspondence, report preparation, verifying data, researching, completing forms collections and data entry. Performs other duties as assigned. Involved in the training of new employees and may take the lead in areas of expertise.
Your role in our mission

  • Resolve suspended medical claims utilizing Medical Assistance Policy.
  • Entry and/or approval of medical Prior Authorizations.
  • Entry and maintenance of third-party insurance information to facilitate coordination of benefits and benefit recovery. Identification of accident-related claims.
  • Identification of accident-related claims
  • Research, entry, and maintenance of HCPC and CPT codes; Entry of nursing home, hospital, federally qualified health centers and ambulatory surgical center rates.
What we're looking for
  • Typically requires 3 - 5 years general experience, or equivalent combination of experience and college-level education.
  • Healthcare, insurance, or third-party billing experience helpful
  • Self-motivated with excellent time management and organizational skills; ability to work independently.
  • Experience with Microsoft Outlook, Word, and proficiency with Excel
  • Ability to interpret healthcare policy, laws, and regulations.

What you should expect in this role
On-site environment located in Warwick, RI. Hybrid possible after training.
#LI-Hybrid
#LI-LS2
The pay range for this position is $30,500.00 - $43,500.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

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Hours and flexibility

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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