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Insurance Claims Policy Processing Clerks Jobs (NOW HIRING)

TEKsystems

Health Insurance Claims Specialist

Honolulu, HI · On-site

$23.33/hr

Review claims, authorizations, benefits, correspondence, policies, procedures, call recordings, and ... Review and process appeals and grievance cases according to organizational policies and regulatory ...

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How much do insurance claims policy processing clerks jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for insurance claims policy processing clerks in the United States is $16.54, according to ZipRecruiter salary data. Most workers in this role earn between $14.66 and $17.79 per hour, depending on experience, location, and employer.

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Infographic showing various Insurance Claims Policy Processing Clerks job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $34,394 per year, or $16.5 per hour.

Insurance Claims Examiner II

Crandon, WI • On-site

Forest County Potawatomi Community
501 - 1,000 employees
Learn more about Forest County Potawatomi Communityexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Here’s what you’ll be doing:

Level II

Level III

1

Analyzes and processes minimum of 200 claims daily to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims

Analyzes and processes minimum of 400 claims to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims

2

Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations

Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations

3

Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments

Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments

4

Assists with other research and development projects as directed by Management; obtains and maintains necessary certification for Health Insurance Marketplace CAC

Provides training and guidance through expert knowledge of claims administration and adjudication to Insurance Department staff; responsible for the timely response to formal appeals from members, employees, clients and providers

5

Reviews, resolves and/or escalates Level 2 claims appeals; releases claims up to the designated draft authority for Level 2 Claims Examiner

Works with the Customer Service Coordinator to manage and provide direction to the utilization review and case management vendor; identifies and manages claims with potential subrogated recovery

6

Ensures that claims adjudication complies with all FCPID standards and protocols; reviews claims for possible abuses and/or fraud and bring to the attention of management

Oversees the repricing processes to ensure the integrity of the product; investigates claims referred by staff for possible abuse and fraud

 What you’ll need to be successful:

Level II

Level III

1

High School Diploma or GED

High School Diploma or GED

2

Five (5) years of experience in medical claims processing

Five (5) years of experience in medical claims processing

3

Three (3) years in customer service

Three (3) years in customer service

4

Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards

Two (2) years in a lead or supervisory capacity

5

Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology

Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards

6

Knowledge of insurance principles and/or procedures

Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology

7

Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment

Knowledge of insurance principles and/or procedures

8

Must successfully pass all applicable background checks and drug screens

Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment

9

Must successfully pass all applicable background checks and drug screens

 Benefits you’ll love:

  • Approximately 5 weeks of paid time off annually
  • 3 weeks of paid holidays
  • Premium free health insurance
  • Flexible spending accounts
  • Short term disability
  • Life insurance
  • 401k with match

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