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Health Claims Jobs (NOW HIRING)

Sutherland

Health Claims Specialists

Louisville, KY · On-site

$13.50/hr

Company Description This is a full-time permanent healthcare claims adjudicator position. A claims adjudicator determines how much money will be paid after an insurance claim has been examined. This ...

Risk Strategies

Health Claims Stop Loss Auditor

$51K - $75K/yr

The Health Claims Stop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

Risk Strategies

Health Claims Stop Loss Auditor

$51K - $75K/yr

The Health ClaimsStop Loss Claims Auditor conducts detailed audits of high-complexity claims files to ensure compliance, accuracy, and adherence to company procedures and regulatory requirements.

woodmenlife

Claims Examiner I or II

The claim examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The claims examiners are responsible for the ...

WoodmenLife

Claims Examiner I or II

Omaha, NE · On-site +1

$17 - $25/hr

The claim examiner communicates with claimants, beneficiaries, health providers or others to gather information and clarify details of the claims. The claims examiners are responsible for the ...

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Health Claims information

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$15

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$27

How much do health claims jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for health claims in the United States is $21.11, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $23.56 per hour, depending on experience, location, and employer.

What is a health claims job?

Health claims jobs involve processing, reviewing, and adjudicating insurance claims related to healthcare services. Professionals in these roles ensure that medical claims are accurate, complete, and comply with insurance policies and regulations. They often work for insurance companies, healthcare providers, or third-party administrators, and may interact with patients, healthcare professionals, and insurers to resolve issues or discrepancies. Common positions in this field include health claims processor, claims examiner, and claims adjuster. Attention to detail, knowledge of medical billing codes, and understanding of healthcare policies are essential for success in health claims jobs.

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

To thrive as a Health Claims Specialist, you need a solid understanding of medical terminology, insurance policies, and claims processing, usually supported by a high school diploma or associate degree in a related field. Familiarity with claims management software, electronic health records (EHR), and industry coding systems like ICD-10 and CPT is typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for resolving discrepancies and interacting with providers or policyholders. These skills ensure accurate, efficient claims processing and help maintain compliance with healthcare regulations and customer satisfaction.

What are some common challenges faced by health claims professionals and how can they be managed?

Health claims professionals often encounter challenges such as processing high volumes of claims accurately and within tight deadlines, interpreting complex medical documentation, and staying updated with changing insurance regulations. Managing these challenges requires strong organizational skills, attention to detail, and continuous training on industry updates. Working closely with healthcare providers and other team members can also help clarify discrepancies and ensure claims are processed efficiently.

What is the difference between Health Claims vs Health Claims Specialist?

AspectHealth ClaimsHealth Claims Specialist
Required CredentialsTypically none or basic certificationsCertifications in health insurance, compliance, or related fields
Work EnvironmentInsurance companies, healthcare providers, government agenciesInsurance firms, healthcare organizations, regulatory bodies
Employer & Industry UsageUsed broadly in health insurance and healthcare sectorsSpecialized role focusing on claims processing and compliance
Common Search & ComparisonUnderstanding health claims processesRoles related to health claims management and review

Health Claims refer to the actual submissions or requests for reimbursement for healthcare services, while a Health Claims Specialist is a professional who reviews, processes, and ensures compliance of these claims. The specialist role involves expertise in insurance policies, regulations, and claims procedures, making it a more specialized position within the healthcare and insurance industries.

What does a health claims specialist do?

A health claims specialist reviews and evaluates insurance claims related to health services to determine coverage eligibility and accuracy. They analyze medical documentation, ensure compliance with policies and regulations, and often use claims processing software to manage cases efficiently.
More about Health Claims jobs

What cities are hiring for Health Claims jobs?

Cities with the most Health Claims job openings:

What states have the most Health Claims jobs?

States with the most job openings for Health Claims jobs include:

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

The top searched job categories for Health Claims jobs are:

Health Claims jobs near you
Infographic showing various Health Claims job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.

Divisional Vice President - Health Claims

Mckinney, TX • On-site

Jobtailor
See more jobs at Jobtailorexternal

$110 - $160/hr

Other

This job post has expired today. Applications are no longer accepted.

Job description


  • Oversee the end-to-end health claims portfolio for limited benefit health products across all Divisions

  • Direct accurate and timely health claims adjudication while maintaining quality standards and SLAs

  • Implement forecasting and capacity planning strategies

  • Develop contingency plans for staffing shortages, high claim volumes, and system transitions

  • Establish, monitor, and report KPIs including turnaround time, quality scores, SLAs, and customer satisfaction

  • Lead, mentor, and develop the claims team through organizational transformation

  • Build relationships with team members and drive accountability, coaching, and performance improvement

  • Advise Senior and Executive leadership on operational performance, trends, best practices, issue resolution, and risk mitigation

  • Develop and present complex operational data and insights to stakeholders

  • Develop and interpret regular and ad hoc reports and escalated issues to Senior management

  • Collaborate cross-functionally on claims initiatives and enterprise-wide best practices

  • Maintain relationships with internal and external stakeholders, regulatory agencies, and business partners

  • Assist with regulatory inquiries and monitor regulatory changes and industry trends affecting health claims


Requirements

  • Bachelor’s degree in business administration, Health Administration, Health Management, Finance, or a related field

  • Minimum of 10 years of progressive experience in health claims operations

  • At least 5 years in a senior leadership or management role

  • Demonstrated expertise in limited benefit, supplemental, or similar health insurance products

  • Minimum of 7-10 years in a people leadership or management role, including direct experience leading managers and multi-layered teams

  • Experience leading teams through organizational change, system implementations, process redesigns, or cultural transformation

  • Proven experience building and sustaining high-performing teams through performance management, coaching, and development

  • Experience overseeing or collaborating with Third Party Administrators (TPAs), including contract performance monitoring and issue resolution

  • Experience developing and managing operational metrics, SLAs, and quality standards in a claims environment

  • Ability to present complex operational data and strategic recommendations to Senior and Executive leadership

  • Deep knowledge of health claims adjudication principles, practices, and compliance requirements for limited benefit health insurance products

  • Ability to review and resolve complex, high-cost, or escalated claims exceeding examiner authority levels

  • Strong understanding of TPA operational models, contract performance standards, and vendor oversight

  • Familiarity with claims adjudication systems and system implementation and optimization

  • Ability to identify training gaps and equip team members with necessary tools and resources

  • Ability to develop action plans for underperforming associates with team leaders and HR Business Partners

  • Experience writing and delivering value-based performance appraisals and conducting performance discussions

  • Ability to implement innovative operational and technical solutions for efficiency, accuracy, and scalability

  • Strong analytical ability to translate data into actionable insights and process improvements

  • Experience leading or supporting enterprise-level system implementations, change management, and team adoption

  • Exceptional written and verbal communication skills

  • Strong interpersonal skills and ability to build trust, navigate competing priorities, and influence outcomes

  • Ability to balance team needs with organizational strategy while driving change

  • Reliable and predictable attendance

  • Ability to work full time and/or part time based on position specifications


Core Competencies

Demonstrates extensive experience in health claims operations, including oversight of limited benefit health products, claims adjudication, and performance management. Proven ability to lead teams through organizational change while developing operational metrics and maintaining compliance with industry standards.


Highest-signal resume keywords

  • Health Claims Operations

  • Limited Benefit Health Insurance Products

  • Team Leadership and Development

  • Operational Metrics and SLAs

  • Claims Adjudication Principles


ATS Optimization Keywords
Hard Skills

  • Health Claims Adjudication

  • Operational Metrics Management

  • Performance Management

  • Data Analysis

  • Process Redesign

  • Regulatory Compliance

  • System Implementation

  • Capacity Planning

  • Contingency Planning

  • KPI Monitoring


Soft Skills

  • Leadership

  • Coaching

  • Communication

  • Interpersonal Skills

  • Problem-Solving


Industry Keywords

  • Health Administration

  • Health Management

  • Supplemental Health Insurance

  • Organizational Transformation

  • Stakeholder Engagement


Tools & Technologies

  • Claims Adjudication Systems

  • Third Party Administrators (TPAs)

  • Performance Monitoring Tools

  • Reporting Tools

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