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Claims Tester Jobs (NOW HIRING)

Scanhealthplan

Claims Analyst

Los Angeles, CA · On-site

Support encounter-data accuracy, claims testing, operational reporting, and internal or external audits by researching claims and gathering required documentation. * We seek Rebels who are curious ...

myPlace Health

$57 - $70/hr

Support encounter-data accuracy, claims testing, operational reporting, and internal or external audits by researching claims and gathering required documentation. * We seek Rebels who are curious ...

myPlace Health

Claims Analyst

Los Angeles, CA · On-site

Support encounter-data accuracy, claims testing, operational reporting, and internal or external audits by researching claims and gathering required documentation. * We seek Rebels who are curious ...

Prosper-Services-LL

Claims Analyst

Compton, CA · On-site

$60 - $80/hr

Support encounter-data accuracy, claims testing, operational reporting, and internal or external audits by researching claims and gathering required documentation.We seek Rebels who are curious about ...

Centivo Corporation

Claims Business Analyst

Buffalo, NY · On-site

$100 - $125/hr

As a Claims Business Analyst, you will be responsible for triaging operational issues and leading ... This includes coordinating user acceptance testing with the operational leads. * Proactively ...

Omega Solutions, Inc.

EDI Tester

Santa Clara, CA · On-site

Client ALM, JIRA preferred. • Experience on testing web applications • Experience with Healthcare Claims Processing Testing. • Must be an excellent team player and be able to prioritize ...

CYNET SYSTEMS

Functional Tester

Cincinnati, OH · On-site

$40 - $45/hr

Execute functional, regression, integration, and UAT testing across loan servicing, claims, policy administration, or related banking modules. * Validate data flows, business rules, financial ...

Centivo

Claims Business Analyst

Buffalo, NY · Remote

$80K - $100K/yr

As a Claims Business Analyst, you will be responsible for triaging operational issues and leading ... This includes coordinating user acceptance testing with the operational leads. * Proactively ...

Palnar

Senior Tester

Reston, VA · On-site

5-8 Years' Experience Must have strong experience with EDI 837 Health Care Claims processing testing Must have strong working knowledge test automation using selenium java script, python cucumber ...

VARITE INC

Guidewire Tester

Plano, TX · On-site

VARITE INC is seeking a Guidewire Tester with strong functional testing experience on Guidewire ... FNOL, Claims lifecycle • Prepare and execute test scenarios, test cases, and test data • ...

Maesa

Senior Manager, Claims Substantiation

New York, NY · On-site

$110K - $130K/yr

Develop testing plans utilizing clinical, consumer, instrumental, laboratory, and expert review methodologies. * Review statistical analyses and technical reports to ensure claims are adequately ...

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Showing results 21-40

All JobsFinance and Insurance JobsInsurance JobsInsurance Claims Examiner JobsClaims Tester Jobs

Claims Tester information

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$41K

$76K

$99K

How much do claims tester jobs pay per year?

As of Sep 7, 2026, the average yearly pay for claims tester in the United States is $76,039.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,000.00 and $85,500.00 per year, depending on experience, location, and employer.

What is a claims tester?

Claims Testers are professionals who evaluate and verify insurance claims to ensure they meet company policies and regulatory requirements. Their primary responsibility is to test claims processing systems, review claim documents, and identify errors or inconsistencies before claims are approved or denied. Claims Testers work closely with claims adjusters and system developers to improve accuracy and efficiency in the claims process. They play a crucial role in maintaining the integrity of an insurance company's claims operations.

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

To thrive as a Claims Tester, you need a strong understanding of insurance claims processes, attention to detail, and experience with quality assurance or testing methodologies, often supported by a relevant degree or claims certification. Familiarity with claims management systems, test automation tools, and defect tracking software is typically required. Analytical thinking, effective communication, and problem-solving skills make someone stand out in this role. These competencies are crucial for ensuring the accuracy and compliance of claims processing systems, which directly impact customer satisfaction and organizational integrity.

What are some common challenges faced by claims testers, and how can they be addressed?

Claims Testers often encounter challenges such as working with complex insurance systems, adapting to frequently changing regulations, and ensuring test cases accurately reflect real-world claim scenarios. Effective communication with developers, business analysts, and claims processors is essential to clarify requirements and resolve discrepancies. To address these challenges, it's helpful to stay updated on industry standards, participate in regular team meetings, and continually refine testing processes based on feedback and observed outcomes.

What is the difference between Claims Tester vs Claims Analyst?

AspectClaims TesterClaims Analyst
Required CertificationsBasic knowledge of insurance and testing certificationsInsurance certifications often preferred, such as CPCU or AIC
Work EnvironmentQuality assurance teams, testing labs, or IT departmentsClaims departments within insurance companies or third-party administrators
Employer & Industry UsageInsurance companies, software vendors, and consulting firmsInsurance carriers, third-party claims processors, and brokers
Common Search & Comparison IntentUnderstanding testing roles in claims processingAnalyzing claims data and processing efficiency

Claims Testers focus on testing insurance claim systems and ensuring software quality, while Claims Analysts evaluate and process insurance claims to determine coverage and payouts. Both roles are essential in the claims process but differ in their primary functions and skill sets.

More about Claims Tester jobs

What are the most commonly searched types of Claims Tester jobs?

The most popular types of Claims Tester jobs are:

What job categories do people searching Claims Tester jobs look for?

The top searched job categories for Claims Tester jobs are:

Claims Tester jobs near you
Infographic showing various Claims Tester job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $76,039 per year, or $36.6 per hour.

Claims Analyst

Scanhealthplan

Los Angeles, CA • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 11 days ago

Job description

myPlace Health is built around a simple but powerful belief: older adults deserve the support they need to live safely, independently, and with dignity in their own communities. As a PACE (Program of All Inclusive Care for the Elderly) organization backed by SCAN Group, myPlace Health brings together customized medical care, social activities, and daily support for participants and their families - all under one roof.

Our centers are more than healthcare facilities. They are vibrant community hubs where participants are known by name, valued, and supported as whole people. Behind that experience is a dedicated, interdisciplinary team working together to coordinate care, remove barriers, and improve quality of life for some of the most medically and socially complex populations.

For employees, myPlace Health offers the opportunity to do deeply meaningful work in a highly collaborative setting. Team members are encouraged to contribute innovative ideas, and grow alongside a mission that prioritizes compassion, respect, and impact. The result is a culture where people feel connected-to their colleagues, their participants, and the communities they serve.

At myPlace Health, work is more than a job. It's a shared commitment to honoring what matters most.

The Claims Analyst is responsible for the accurate, timely, and compliant processing and adjudication of professional, institutional, and ancillary claims. This position researches and resolves complex claim issues, monitors electronic claim activity, maintains claims-related provider and reimbursement configurations, and identifies trends that may affect payment accuracy. The Claims Analyst works collaboratively with providers, internal departments, and external vendors to resolve claims issues, support encounter-data accuracy, and recommend process improvements in accordance with provider contracts, payment policies, and applicable CMS, DHCS, PACE, and organizational requirements.

RESPONSIBILITIES:

  • Review and adjudicate professional, institutional, and ancillary claims in accordance with provider contracts, benefit plans, regulatory requirements, and payment policies.
  • Research and resolve suspended, pended, denied, or incorrectly processed claims requiring manual intervention or additional analysis.
  • Monitor claims activity to help ensure claims are processed accurately and within applicable CMS, DHCS, and internal timely-payment requirements.
  • Monitor daily electronic data interchange activity, identify transmission failures, and coordinate issue resolution with vendors and internal stakeholders.
  • Maintain provider records, fee schedules, reimbursement methodologies, contract terms, and related configuration within the claims processing system.
  • Validate claims configuration updates following contract implementations, reimbursement changes, or system updates.
  • Respond to provider inquiries regarding claim status, payment determinations, denials, and claims research.
  • Identify trends related to billing, utilization, payment accuracy, provider behavior, and recurring claims issues, and escalate findings as appropriate.
  • Participate in root-cause analysis and recommend workflow or process improvements that support automation, payment accuracy, and operational efficiency.
  • Support encounter-data accuracy, claims testing, operational reporting, and internal or external audits by researching claims and gathering required documentation.
  • We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
  • Actively support the achievement of myPlace Health's Vision and Goals
  • All other duties as assigned.
QUALIFICATIONS & EXPERIENCE:
  • Minimum of five years of experience in health plan claims administration.
  • Strong knowledge of healthcare claims processing systems; experience with QuickCap is preferred.
  • Knowledge of electronic data interchange workflows and coordination of benefits.
  • Understanding of CMS and DHCS requirements related to claims processing, timely payment, and encounter-data submission.
  • Experience researching and resolving complex claims issues, including suspended, pended, denied, or incorrectly processed claims.
  • Ability to interpret provider contracts, reimbursement methodologies, fee schedules, benefit plans, and payment policies.
  • Strong analytical, problem-solving, and root-cause analysis skills.
  • Strong written and verbal communication skills.
  • Proficiency in Microsoft Excel, Power BI, or similar reporting and data-analysis tools.
  • Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related field; an equivalent combination of education and relevant claims experience may be considered.

Experience Preferred:

  • 5-7 years of related experience
  • Experience working in a PACE, Medicare Advantage, or Medi-Cal managed-care environment.
  • Experience with Athena, VisibilEDI, or integrations between electronic medical record and claims-processing platforms.
  • Working knowledge of payment-integrity concepts, including modifier validation, no-downcoding requirements, and overpayment recovery.
  • Experience supporting claims audits, system testing, configuration validation, and process-improvement initiatives.

What's in it for you?

Base salary range: $63,352.00 per year

Work Mode: Remote

An annual employee bonus program

Medical, Dental, Vision coverage

Generous paid-time-off (PTO)

11 paid holidays per year, plus 1 additional floating holiday

Excellent 401(k) Retirement Saving Plan with employer match.

Robust employee recognition program

Robust Wellness Program

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