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Health Claims Jobs (NOW HIRING)

Healthcare Claims Examiner Location: Whittier, CA Shift: Monday - Friday | 7:00 AM - 3:30 PM Position Overview We are seeking an experienced Claims Examiner with strong UB-92 and HCFA-1500 claims ...

Hospital Claims Processor V

Manhattan, NY

$18.75 - $23.75/hr

Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required * Basic keyboarding skills required * Strong knowledge of ...

Hospital Claims Processor V

Manhattan, NY · On-site

$18.75 - $23.75/hr

Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required * Basic keyboarding skills required * Strong knowledge of ...

Claims Follow-Up Lead Behavioral Health | Government & Commercial Payers | Lean Growth Organization | Remote WellPsyche Medical Group is a leading telehealth behavioral health organization providing ...

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How much do health claims jobs pay per hour?

As of Jun 8, 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 are the key skills and qualifications needed to thrive as a Health Claims Specialist, and why are they important?

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 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 are health claims jobs?

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 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.
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:
Infographic showing various Health Claims job openings in the United States as of May 2026, with employment types broken down into 1% Locum Tenens, 11% Full Time, 64% Part Time, 1% Temporary, 22% Contract, and 1% Nights. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.

Senior Manager, Stop Loss & Health Claims

Sun Life Financial

Milwaukee, WI • On-site, Remote

$68K - $102K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago


Sun Life Assurance Company of Canada rating

8.6

Company rating: 8.6 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

73rd of 260 rated insurance


Job description

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.

Job Description:

Sun Life embraces a hybrid work model that balances in-office collaboration with the flexibility of virtual work in the contiguous states plus AK.

The opportunity: The Senior Manager, Stop Loss and Health Claims leads our dynamic claims unit. In this critical role, you'll oversee complex claims operations, manage a high-performing team, and collaborate with key partners to drive our continued growth and excellence in customer service.

How you will contribute:

  • Lead Claims Operations: Direct the evaluation, investigation, negotiation, and settlement of complex claims, ensuring optimal balance between policyholder interests and company objectives.
  • Manage and Develop Staff: Supervise, mentor, and grow a talented claims team, overseeing work assignments, performance management, and professional development.
  • Optimize Processes: Monitor workflow, implement efficiencies, and ensure prompt, accurate claims processing to enhance operational effectiveness.
  • Collaborate with Partners: Work closely with third-party administrators, brokers, agents, policyholders, vendors, and legal counsel to maintain Sun Life's strong reputation and drive business growth.

What you will bring with you:

  • Ability to work with a diverse range of people
  • 5+ years of medical stop loss insurance or health insurance claims experience required, previous management/leadership experience preferred
  • Proven leadership skills and deep industry expertise
  • Strong analytical and problem-solving abilities
  • Experience in stakeholder management and customer-facing roles
  • In-depth knowledge of claims practices, state and federal laws
  • Excellent communication and negotiation skills
  • Ability to analyze and communicate complex data and trends
  • Proficiency with claims management systems and Sun Life products

Salary:

$68,200-$102,300

At our company, we are committed to pay transparency and equity. The salary range for this role is competitive nationwide, and we strive to ensure that compensation is fair and equitable. Your actual base salary will be determined based on your unique skills, qualifications, experience, education, and geographic location. In addition to your base salary, this position is eligible for a discretionary annual incentive award based on your individual performance as well as the overall performance of the business. We are dedicated to creating a work environment where everyone is rewarded for their contributions.

Not ready to apply yet but want to stay in touch? Join our talent community to stay connected until the time is right for you!

We are committed to fostering an inclusive environment where all employees feel they belong, are supported and empowered to thrive. We are dedicated to building teams with varied experiences, backgrounds, perspectives and ideas that benefit our colleagues, clients, and the communities where we operate. We encourage applications from qualified individuals from all backgrounds.

Life is brighter when you work at Sun Life

At Sun Life, we prioritize your well-being with comprehensive benefits, including generous vacation and sick time, market-leading paid family, parental and adoption leave, medical coverage, company paid life and AD&D insurance, disability programs and a partially paid sabbatical program. Plan for your future with our 401(k) employer match, stock purchase options and an employer-funded retirement account. Enjoy a flexible, inclusive and collaborative work environment that supports career growth. We're proud to be recognized in our communities as a top employer. Proudly Great Place to Work Certified in Canada and the U.S., we've also been recognized as a "Top 10" employer by the Boston Globe's "Top Places to Work" for two years in a row. Visit our website to learn more about our benefits and recognition within our communities.

We will make reasonable accommodations to the known physical or mental limitations of otherwise-qualified individuals with disabilities or special disabled veterans, unless the accommodation would impose an undue hardship on the operation of our business. Please email thebrightside@sunlife.comto request an accommodation.

For applicants residing in California, please read our employee California Privacy Policy and Notice.

We do not require or administer lie detector tests as a condition of employment or continued employment.

Sun Life will consider for employment all qualified applicants, including those with criminal histories, in a manner consistent with the requirements of applicable state and local laws, including applicable fair chance ordinances.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

Job Category:

Claims - Health & Dental

Posting End Date:

29/06/2026

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