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Health Claims Jobs (NOW HIRING)

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.

Orthofix

Health Claims Collections Specialist II

$19 - $25.50/hr

JOB PURPOSE The Specialist II, Health Claims Collections is responsible for resolving complex post-payment and denied DME claims. Operating within a wing-to-wing revenue cycle management team, this ...

1199SEIU Funds

Hospital Claims Processor V

Manhattan, NY · On-site

$18.75 - $23.75/hr

... health insurance or benefits environment required Basic keyboarding skills required Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims ...

True Behavioral Health LP

Claims Specialist

Irvine, CA · On-site

$27 - $30/hr

Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ...

Managed Staffing

Healthcare Claims Examiner

Whittier, CA · On-site

$31 - $32/hr

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 ...

True Behavioral Health LP

Claims Specialist

Irvine, CA · On-site

$27 - $30/hr

Looking for an experienced Behavioral Health Claims Follow-Up Specialist to join our Revenue Cycle team. This role is responsible for managing insurance claims follow-up, resolving denials, and ...

1199SEIU Funds

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 ...

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Health Claims information

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$15

$21

$27

How much do health claims jobs pay per hour?

As of Jul 23, 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.

Do I need a degree to be a claims specialist?

A degree is not always required to become a health claims specialist, but many employers prefer candidates with a high school diploma or equivalent. Relevant skills such as knowledge of insurance policies, attention to detail, and familiarity with claims processing software are important, and some roles may require certification or training programs.

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.

How to get into healthcare claims?

To enter healthcare claims roles, candidates typically need a high school diploma or equivalent, with some positions preferring postsecondary education or certifications in medical billing or coding. Relevant skills include attention to detail, knowledge of insurance procedures, and familiarity with claims processing software; certifications like Certified Professional Coder (CPC) can improve job prospects.

What is the easiest healthcare job that pays well?

A health claims specialist is considered an accessible healthcare role that offers competitive pay, often requiring only a high school diploma or certification in health insurance processing. The job involves reviewing and processing insurance claims, with some positions offering remote work and flexible schedules.

What is the highest paying adjuster job?

The highest paying adjuster jobs are often senior or specialized roles such as catastrophe or large-loss adjusters, who handle complex claims and may earn six-figure salaries. These positions typically require extensive experience, industry certifications, and strong negotiation skills. Compensation varies by region and employer, but specialization and experience are key factors in higher pay.

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:
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 July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.
Health Claims Stop Loss Auditor

Health Claims Stop Loss Auditor

Risk Strategies

Remote

$51K - $75K/yr

Full-time

Posted 27 days ago

Risk Strategies rating

7.5

Company rating: 7.5 out of 10

Based on 29 frontline employees who took The Breakroom Quiz

203rd of 281 rated insurance

Job description

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.
Your Impact
  • Perform in-depth claims file reviews for accuracy and compliance.
  • Document findings and provide recommendations for corrective action.
  • Identify trends and collaborate with departments to improve claim practices.
  • Support audit reporting and analytics.

Successful Candidate Will Have
  • Bachelor's degree preferred; CPCU, AIC, or other insurance certifications a plus.
  • 4 - 6 years of claims or audit experience.
  • Strong understanding of claims handling and insurance regulations.
  • Analytical, organized, and skilled in Excel/audit systems.

Brown & Brown, Inc. (NYSE: BRO) is a leading insurance brokerage firm delivering comprehensive and customized insurance solutions and specialization since 1939. With a global presence spanning 700+ locations and a team of approximately 23,000 professionals, we are dedicated to delivering scalable, innovative strategies for our customers at every step of their growth journey. Learn more at BBrown.com.
Pay Range:
$51,800 - $75,000 Annual
The pay range provided above is made in good faith and based on our lowest and highest annual salary or hourly rate paid for the role and takes into account years of experience required, geography, and/or budget for this role.
Brown & Brown, Inc. and our team of companies is an equal opportunity workplace and is committed to ensuring equal employment opportunity without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, Veteran status, or other legally protected characteristics. Learn more about working at Risk Strategies, part of the Brown & Brown team, by visiting https://us.bbrown.com/careers/.
Personal information submitted by California applicants in response to a job posting is subject to Risk Strategies' California Job Applicant Privacy Notice.
Recruiting Vendor Disclosure Statement
Brown & Brown does not accept unsolicited resumes from external recruiters, recruitment vendors or employment agencies ("Recruiting Vendors"). Recruiting Vendors must have a valid written agreement and receive prior written authorization from an authorized Brown & Brown representative before submitting candidates for any publicly posted role. Any unsolicited resumes submitted to Brown & Brown or its employees become the property of Brown & Brown, and no fees will be paid for such submissions. Additional information regarding this policy can be found on our careers page.

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