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Healthcare Claims Management Jobs (NOW HIRING)

North East Medical Services

MSO CLAIMS MANAGER

Burlingame, CA · On-site

$112K - $128K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

This role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal ... Prepare reports for senior management on claims performance, backlog, and issue resolution.

MSO, INC. OF SOUTHERN CALIFORNIA

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CLAIMS MANAGER

Costa Mesa, CA · Remote

$80K - $110K/yr

Reporting directly to the CEO/President and Compliance Officer, this remote position requires expertise in regulatory compliance and claims processing within a healthcare management environment.

Posted today

Health Source MSO

Claims Auditor

Alhambra, CA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Bachelor's degree in related field or AA degree with related experience Must have at least 5 years of applicable healthcare claims adjudication experience within a managed care industry Must be ...

LTCG

Claims Manager

Eden Prairie, MN · Hybrid

$60K/yr

... risk management insight built upon our proprietary long term care databases. The Claims Manager ... healthcare providers via written letters and phone calls as required by agreed upon SLAs and.

OMS MEDICAL BILLING LLC

Claims In-take Specialist

Addison, TX

$20 - $25/hr

  • Medical

  • Dental

  • Vision

  • Retirement

OrthoMed Anesthesia is seeking a detail-oriented Healthcare Claims Intake Specialist to join our growing anesthesia practice management team. This role is critical in ensuring accurate and timely ...

Village Care

Manager Claims Healthcare

Manhattan, NY · On-site

$118K - $132K/yr

This position will lead a team of claims analysts and will work closely with the Network Management ... VillageCare has delivered quality health care services to individuals residing within New York City ...

Village Care

Manager Claims Healthcare

Manhattan, NY · On-site

$118K - $132K/yr

This position will lead a team of claims analysts and will work closely with the Network Management ... VillageCare has delivered quality health care services to individuals residing within New York City ...

UHS

Claims Auditor/Trainer

Reno, NV · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Responsibilities Prominence Health is a value-based care organization bridging the gap between ... in the absence of Claims Managers or Supervisors. The position collaborates with internal ...

Humana

Claims Processing Professional

Miramar, FL

$53K - $72K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience processing medical, home health, or managed care claims. * Knowledge of CPT, ICD-10, and HCPCS coding. * Experience working with provider contracts, authorizations, or eligibility ...

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Showing results 21-40

All JobsHealthcare Claims Management Jobs

Healthcare Claims Management information

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$35K

$87.9K

$139K

How much do healthcare claims management jobs pay per year?

As of Aug 17, 2026, the average yearly pay for healthcare claims management in the United States is $87,861.00, according to ZipRecruiter salary data. Most workers in this role earn between $68,000.00 and $105,000.00 per year, depending on experience, location, and employer.

What is the difference between Healthcare Claims Management vs Medical Billing Specialist?

AspectHealthcare Claims ManagementMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies, coding, and claims processing; certifications like CPC or CCS are commonRequires coding and billing knowledge; certifications like CPC are often preferred
Work EnvironmentOften in healthcare offices, insurance companies, or claims processing centersPrimarily in medical offices, hospitals, or billing companies
Job FocusManaging and processing insurance claims, resolving claim denials, ensuring compliancePreparing and submitting patient bills, coding procedures, and following up on payments
Industry UsageUsed across healthcare providers, insurance companies, and third-party administratorsPrimarily used within healthcare providers' billing departments

While both roles involve billing and coding, Healthcare Claims Management focuses on overseeing the entire claims process, including denials and compliance, whereas Medical Billing Specialists handle the day-to-day billing and coding tasks for patient accounts.

Is healthcare claims management a stressful job?

Healthcare claims management can be stressful due to the need for accuracy, meeting deadlines, and handling complex insurance policies. The role often requires attention to detail, strong organizational skills, and the ability to manage high workloads, especially during busy periods or audits.

What is healthcare claims management?

Healthcare claims management is the process of handling medical insurance claims, from submission to reimbursement. It involves reviewing, processing, and following up on claims sent to insurance companies by healthcare providers. The goal is to ensure that providers are accurately paid for services rendered and that patients' insurance benefits are correctly applied. Effective claims management helps reduce denials, improve cash flow, and minimize administrative errors in healthcare billing.

What are the key skills and qualifications needed to thrive in healthcare claims management?

To thrive in Healthcare Claims Management, you need a solid understanding of medical billing, insurance policies, coding systems (such as ICD-10 and CPT), and typically a relevant associate’s or bachelor’s degree. Familiarity with claims processing software, electronic health record (EHR) systems, and regulatory compliance tools is essential. Strong attention to detail, analytical thinking, and effective communication help you resolve discrepancies and interact with providers and payers. These skills are crucial for ensuring accurate claims processing, minimizing denials, and maintaining efficient revenue cycles in healthcare organizations.

What are some common challenges faced in healthcare claims management, and how can professionals effectively address them?

Healthcare claims management professionals often encounter challenges such as processing complex claims, navigating frequent regulatory changes, and handling denied or delayed claims. To address these issues, professionals must stay updated on the latest healthcare regulations and payer requirements and develop strong attention to detail when reviewing documentation. Collaborating closely with billing teams and insurance providers, as well as using advanced claims management software, can help streamline workflows and reduce errors, ultimately improving the accuracy and efficiency of claims processing.
More about Healthcare Claims Management jobs

What cities are hiring for Healthcare Claims Management jobs?

Cities with the most Healthcare Claims Management job openings:

What states have the most Healthcare Claims Management jobs?

States with the most job openings for Healthcare Claims Management jobs include:

What job categories do people searching Healthcare Claims Management jobs look for?

The top searched job categories for Healthcare Claims Management jobs are:

Healthcare Claims Management jobs near you
Infographic showing various Healthcare Claims Management job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $87,861 per year, or $42.2 per hour.

MSO CLAIMS MANAGER

North East Medical Services

Burlingame, CA • On-site

$112K - $128K/yr

Other

Medical, Dental, Vision, Retirement

Re-posted 9 days ago

Job description

The Claims Manager is responsible for overseeing the end-to-end claims operations within the MSO managed care delegated functions. This role provides guidance on healthcare claims adjudication and payment processing for Medi-Cal, Medicare, PACE, and other lines of business based on member Evidence of Coverages (EOC) and CMS/DHCS guidelines, ensures that claims are processed accurately, timely, and in compliance with regulatory requirements and contractual obligations. The Claims Manager will lead the claims team, implement process improvements, and collaborate with internal and external stakeholders to optimize claims adjudication workflows.
This role requires high-level of decision-making and problem-solving skills in relates to claims operations, compliance, and process improvements. Deep understanding of Medi-Cal, Medicare Advantage, PACE, CMS, and DHCS regulations; ensuring full compliance across the department. Ability to manage multiple priorities, oversee department workflows, and optimize resource allocation. Responsible to design training programs for claims teams and leads initiatives to enhance team expertise. Excellent communication skills to interact with leadership, payers, providers, auditors, and MSO internal departments.
ESSENTIAL JOB FUNCTIONS:
  • Oversee managed care claims processing, ensuring compliance with CMS, DHCS, and health plan guidelines.
  • Monitor claims adjudication, ensuring accuracy, timeliness, and regulatory adherence.
  • Develop and implement policies and procedures to improve claims processing efficiency.
  • Work with IT and system vendors to optimize claims processing systems and troubleshoot issues.
  • Lead and mentor the claims team, including Claims Supervisors and processors, ensuring high performance and engagement.
  • Conduct regular performance evaluations, design training programs, provide training, and develop staff competencies.
  • Establish and monitor productivity metrics to enhance team efficiency.
  • Serve as the primary liaison with health plans, providers, auditors, and third-party administrators to resolve claims issues and disputes.
  • Manage escalations, appeals, and grievances related to claims processing.
  • Coordinate with provider relations to address claims denials and payment disputes.
  • Identify areas for process improvement and implement best practices to enhance claims adjudication.
  • Analyze claims data, trends, and key performance indicators to drive operational enhancements.
  • Prepare reports for senior management on claims performance, backlog, and issue resolution.
  • Direct supervision of a department involving responsibility for results in terms of costs, methods and personnel. Responsible for carrying out supervisory/managerial responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing and hiring of employees; planning, assigning, scheduling, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
  • Performs other job duties as required by manager/supervisor.

QUALIFICATIONS:
  • Bachelor's degree in business, healthcare administration, or related field is preferred; Associate's degree may be considered with relevant, equivalent work experience.
  • Experience: Minimum of 5 years in managed care claims and compliance field, with at least 3 years in a managerial role within an IPA, health plan, medical group, or TPA.
  • Knowledge of: Medi-Cal and MA claims processing, CMS and DHCS regulations, capitated vs. fee-for-service (FFS) models, claims adjudication systems (e.g., EZ-CAP, HealthEdge, Tapestry, or similar).
  • Skills: Strong analytical, problem-solving, and leadership skills. Proficiency in Excel, reporting tools, and claims systems.
  • Certifications (Preferred): AAHAM, CPC, or other relevant claims-related certifications.

LANGUAGE:
  • Must be able to fluently speak, read and write English.
  • Fluency in other languages are an asset.

STATUS:
  • This is an FLSA Exempt position.
  • This is not an OSHA high-risk position.
  • This is a full-time position.

NEMS is proud to be an Equal Opportunity Employer welcoming diversity in our workforce. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).

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