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Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. * Re-adjudicate, adjust ...

Adjudicate medical, dental and mental health claims in accordance and compliance with plan provisions, state and federal regulations, and CareOregon policies and procedures. * Re-adjudicate, adjust ...

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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 24, 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:
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.
Associate Director, Supplemental Health Claims Operations

Associate Director, Supplemental Health Claims Operations

Sun Life Financial

Portland, ME • Hybrid

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 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

77th of 281 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.


At Sun Life, we're driven by our Purpose: helping our Clients achieve lifetime financial security and live healthier lives. Our values shape how we work: caring, authentic, bold, inspiring, and impactful.


When you join Sun Life, you'll work with passionate colleagues and empowering leaders who support your growth and celebrate your contributions, so you can make a meaningful difference in our Clients' lives.


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

Job Description:

This is a hybrid role; requiring two days a week on site at one of our core office locations

The Opportunity:

This is an exciting opportunity to lead a high-performing Supplemental Health Claims team within an organization known for its strong culture, commitment to clients, and focus on helping people in moments that matter. The Associate Director, Supplemental Health Claims, will provide strategic leadership and operational oversight for claims and service functions, helping shape a best-in-class experience for claimants, clients, and partners. This leader will drive service excellence, modernize end-to-end claims operations, strengthen regulatory and operational controls, and develop talented teams that are accountable, collaborative, and focused on continuous improvement.

What you will do:

Why This Role Matters

  • Play a highly visible leadership role in a growing and important part of the business.
  • Lead meaningful transformation across claims operations, service delivery, digital enablement, and process improvement.
  • Work with a collaborative, high-performing team that values accountability, development, and a strong service mindset.
  • Partner with leaders across Product, Technology, Legal, Compliance, Finance, Customer Experience, and Operations to deliver better outcomes for clients and claimants.

Key Responsibilities

Strategic Leadership & Execution

  • Execute a forward-looking claims strategy aligned with enterprise objectives, client needs, and market expectations.
  • Lead modernization initiatives that improve speed, quality, consistency, and the overall claimant and client experience.
  • Establish clear operational performance standards, KPIs, quality benchmarks, and operating rhythms to drive accountability and continuous improvement.
  • Use data, insights, and operational expertise to identify opportunities, prioritize process improvements, and deliver measurable outcomes.

Operational Excellence

  • Oversee day-to-day claims operations across multiple product lines, ensuring work is handled accurately, efficiently, and with strong service discipline.
  • Ensure seamless handling of complex, high-visibility, or escalated claims and service matters.
  • Drive continuous process improvement using data insights, Agile and Lean practices, automation, and workflow optimization.
  • Monitor operational capacity, resource allocation, service levels, productivity, quality, and risk indicators.

People Leadership & Team Development

  • Lead, coach, and develop claims managers and team members, creating an environment where people can do their best work and grow their careers.
  • Foster a culture of accountability, inclusion, collaboration, service excellence, and continuous learning.
  • Support workforce planning, training, talent development, engagement, and retention strategies.
  • Build team morale and strengthen employee experience through clear expectations, meaningful feedback, and visible leadership.

Compliance, Risk & Controls

  • Ensure adherence to federal and state regulations, internal policies, contractual obligations, and industry standards.
  • Partner with Legal, Compliance, Audit, Privacy, and operational risk teams to proactively identify, assess, and mitigate risks.
  • Maintain strong controls, documentation, and governance practices that protect data integrity, privacy, and operational resilience.
  • Promote a risk-aware culture while enabling efficient, client-centered execution.

Qualifications

  • Collaborate with Product, Underwriting, Technology, Finance, Customer Experience, and Operations teams to support business goals and strengthen service delivery.
  • Serve as a trusted claims subject matter expert in client meetings, escalations, audits, and strategic initiatives.
  • Represent the claims organization in cross-functional steering committees, enterprise projects, and transformation efforts.
  • Build strong relationships with internal and external partners to support client retention, operational readiness, and improved outcomes.

What you will bring with you:

Education & Experience

  • Bachelor's degree required; advanced degree or industry designation such as CPCU, AIC, or a related credential preferred.
  • 5+ years of progressive claims leadership experience, ideally within insurance, health benefits, supplemental health, or a related service environment.
  • Demonstrated success leading teams, managing complex operations, and delivering measurable improvements in quality, service, productivity, and customer experience.
  • Experience leading change, modernization, or transformation initiatives in a regulated environment.

Skills & Competencies

  • Strategic thinker with strong analytical, operational, and business acumen.
  • Proven ability to inspire teams, build trust, communicate clearly, and lead through change.
  • Strong relationship-building skills with the ability to influence across functions and levels.
  • Comfort using workflow systems, digital workflows, dashboards, and data to improve decisions and outcomes.
  • Sound judgment, attention to detail, and the ability to balance service, quality, compliance, and operational efficiency.

What We Offer

  • A chance to join a collaborative, high-performing team with meaningful visibility and impact.
  • An organization with a strong company culture, clear purpose, and commitment to helping clients and claimants when they need support most.
  • Opportunities to lead transformation, influence strategy, and shape the future of Supplemental Health claims operations.
  • A leadership environment that values accountability, continuous improvement, employee development, and strong partnerships.

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. National Average Salary Range: $95,700 - $143,600

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:

Absence / Leave Management

Posting End Date:

16/08/2026

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