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Healthcare Claims Representative Jobs (NOW HIRING)

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Job Title : Healthcare Claims Adjuster Location : Baltimore, Maryland (meetings and tranings) Type: Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD ...

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

... health plan administration, holistic wellbeing solutions, and comprehensive care navigation ... You'll lead a team of claims examiners, drive process improvements, and partner across the ...

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

... health plan administration, holistic wellbeing solutions, and comprehensive care navigation ... You'll lead a team of claims examiners, drive process improvements, and partner across the ...

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

... health plan administration, holistic wellbeing solutions, and comprehensive care navigation ... You'll lead a team of claims examiners, drive process improvements, and partner across the ...

Brown & Brown

Senior Claims Representative

Carmel, IN · On-site

Senior Claims Representative Built on meritocracy, our unique company culture rewards self-starters ... Health Benefits: Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance * Financial ...

Tmhcc

Lead Healthcare Claims Assistant

Chicago, IL · Hybrid

$29.90 - $51.35/hr

Lead Healthcare Claims Assistant Location: New York or Chicago Work Schedule: Hybrid Employment Type: Full time Requisition Begin Date: 8/19/2026 Help us insure it Tokio Marine HCC is a global ...

NTT DATA

Healthcare Claims Processor, Remote

$17.50 - $22/hr

Correctly calculating claims payable amount using applicable methodology/fee schedule Requirements: * 1-3 years hands-on experience in Healthcare Claims Processing * 2+ years using a computer with ...

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Healthcare Claims Representative information

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How much do healthcare claims representative jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for healthcare claims representative in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What does a healthcare claims representative do?

A Healthcare Claims Representative is responsible for processing and reviewing medical insurance claims submitted by healthcare providers or patients. They verify the accuracy of information, ensure that claims comply with insurance policies, and determine the coverage and payment amounts. Their work involves communicating with healthcare providers, patients, and insurance companies to resolve any discrepancies or issues. By efficiently handling claims, they help ensure timely reimbursement and maintain the integrity of the claims process.

What are the key skills and qualifications needed to thrive as a healthcare claims representative, and why are they important?

To thrive as a Healthcare Claims Representative, you need a solid understanding of medical terminology, insurance processes, and claims adjudication, often supported by a high school diploma or associate degree. Familiarity with claims management software, EHR systems, and coding tools like ICD-10 and CPT is typically required. Strong attention to detail, problem-solving abilities, and effective communication skills help you resolve discrepancies and work with providers and patients. Mastering these skills ensures accurate claims processing, minimizes errors, and supports efficient reimbursement and client satisfaction.

What are common challenges faced by healthcare claims representatives and how can they be managed?

Healthcare Claims Representatives often encounter challenges such as navigating complex insurance policies, resolving claim discrepancies, and ensuring compliance with healthcare regulations. Managing these challenges requires strong attention to detail, effective communication skills, and the ability to stay organized under tight deadlines. Building a collaborative relationship with healthcare providers and insurers, as well as staying updated on policy changes, can help representatives resolve issues efficiently and maintain a high level of accuracy in their work.

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

AspectHealthcare Claims RepresentativeMedical Billing Specialist
CredentialsHigh school diploma; certifications like Certified Professional Coder (CPC) or claims-specific trainingHigh school diploma; certifications such as CPC or Certified Medical Billing Specialist (CMBS)
Work EnvironmentInsurance companies, healthcare providers, billing officesMedical offices, hospitals, billing companies
Job FocusReviewing, submitting, and following up on insurance claimsPreparing and submitting medical bills, managing accounts receivable

While both roles involve handling medical billing and insurance processes, Healthcare Claims Representatives primarily focus on managing insurance claims, ensuring proper submission and follow-up. Medical Billing Specialists handle the overall billing process, including preparing bills and managing payments. Both roles require similar certifications and often work in healthcare or insurance settings, but their core responsibilities differ slightly.

What cities are hiring for Healthcare Claims Representative jobs?

Cities with the most Healthcare Claims Representative job openings:

What states have the most Healthcare Claims Representative jobs?

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

What are popular job titles related to Healthcare Claims Representative jobs?

For Healthcare Claims Representative jobs, the most frequently searched job titles are:

Infographic showing various Healthcare Claims Representative job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 67% Full Time, 14% Part Time, and 17% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.

Healthcare Claims Adjuster

Baltimore, MD • Remote

System One
Business Consulting Services • 5 - 10K employees
Learn more about System Oneexternal

$25/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 24 days ago

Job description

Job Title: Healthcare Claims Adjuster

Location: Baltimore, Maryland (meetings and tranings) Type: Contract To Hire Compensation: $25/HR Contractor Work Model: 80% Remote (must reside in D.C., MD, or VA per client)

About the Role We’re hiring a Healthcare Claims Adjuster with a strong claims processing background and exposure to adjustments, rework, or dispute resolution who wants to grow in that area. The role involves handling claims adjustments, discrepancies, and provider dispute work.

This is a fast-paced role with the opportunity to build hands-on adjustment experience and potential for long-term growth. What You’ll Do Processing (Training Ramp-Up)

  • Process medical claims and learn systems and workflows
Adjustments & Disputes (Core Role)
  • Investigate and resolve claim discrepancies and provider disputes
  • Perform adjustments, reprocessing, and corrections
  • Review overpayments, underpayments, and errors
Daily Operations
  • Handle high volume (~50 cases/day after ramp-up)
  • Update claims systems and maintain accurate records
  • Shift between processing and adjustment work
Quality & Accuracy
  • Identify trends and exceptions
  • Ensure accuracy and compliance
Why This Role Is a Great Fit
  • Grow adjustment expertise (not just processing)
  • Exposure to complex claims and dispute resolution
  • High-impact work on claim backlog
  • Mostly remote, flexible work model
  • Contract-to-hire with potential for full-time conversion based on performance
What You Bring Required Skills:
  • 2+ years of medical claims experience
  • Strong claims processing background
  • Adjustment experience (rework, discrepancies, or dispute resolution)
  • Ability to work in a fast-paced, high-volume environment
  • Strong attention to detail and problem-solving skills
Nice to Have (sets you apart):
  • Payer-side experience
  • FACETS or similar claims system experience
  • Exposure to refunds, subrogation, or workers’ compensation

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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