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Insurance Claims Processing Jobs in New Jersey (NOW HIRING)

Crox Consulting Inc

Claims Specialist

Englewood, NJ · On-site

$25/hr

Collaborate with team members in the Product Safety department, PL Insurance Carrier, outside law ... Process, procedure, strategic planning and project development experience Experience working with ...

UFCW Local 464A

Be Seen First

Benefit Administrator

Little Falls, NJ · On-site

Benefits, insurance, claims processing, or administrative experience preferred, but not required * Bilingual preferred Benefits * No-copay family medical coverage - including dental and vision * Two ...

Berkley

Claims Specialist

Jersey City, NJ · On-site +1

$100K - $150K/yr

We provide a comprehensive portfolio of commercial property casualty insurance, automobile ... This individual would be responsible for reviewing, processing, investigating, evaluating ...

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All JobsInsurance Claims Processing JobsInsurance Claims Processing Jobs in New Jersey

Insurance Claims Processing information

What is insurance claims processing?

Insurance claims processing is the procedure by which insurance companies review, investigate, and settle claims made by policyholders. This process involves verifying the details of a claim, ensuring it meets the terms of the policy, and determining the appropriate payout or action. Claims processors handle documentation, communicate with claimants, and may work with other parties like adjusters or healthcare providers. The goal is to ensure claims are resolved efficiently, accurately, and fairly according to policy guidelines.

What are the key skills and qualifications needed to thrive in insurance claims processing?

To excel in Insurance Claims Processing, you need strong attention to detail, analytical abilities, and a foundational understanding of insurance policies or claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, databases, and sometimes industry certifications like AIC (Associate in Claims) is common. Effective communication, problem-solving skills, and the ability to manage stressful situations make someone stand out in this role. These competencies are critical for ensuring claims are processed accurately, efficiently, and in compliance with regulatory standards.

What are some common challenges faced in insurance claims processing, and how can new team members effectively manage them?

In insurance claims processing, new team members often encounter challenges such as handling high volumes of claims, interpreting complex policy language, and communicating effectively with policyholders and other stakeholders. To manage these challenges, it's important to develop strong organizational skills, stay detail-oriented, and proactively seek clarification when unsure about policy terms or procedures. Collaborating with experienced colleagues and taking advantage of ongoing training opportunities can also help new processors build confidence and efficiency in their daily tasks.

What is the difference between Insurance Claims Processing vs Insurance Adjuster?

AspectInsurance Claims ProcessingInsurance Adjuster
CredentialsTypically requires a high school diploma or equivalent; certifications like CPCU or AIC are commonRequires a high school diploma; certifications like AIC or state licensing often needed
Work EnvironmentOffice-based, processing claims via computer systemsField and office work, inspecting damages and interviewing claimants
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Primary FocusReviewing and processing insurance claims efficientlyAssessing damages and determining claim validity and payout

While both roles are essential in the insurance industry, Insurance Claims Processing focuses on handling and managing claims paperwork, whereas Insurance Adjusters evaluate damages and determine claim settlements. Understanding these differences helps job seekers identify the right career path within the insurance sector.

How to get a job as an insurance claims processor?

To become an insurance claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training or certifications in insurance or claims processing. Relevant skills include attention to detail, communication, and familiarity with claims management software. Gaining experience through internships or entry-level positions can improve job prospects, and some employers may require background checks or specific licensing depending on the state or company policies.

Is insurance claims processing a stressful job?

Insurance claims processing can be a stressful job due to tight deadlines, high workload, and the need for accuracy in evaluating claims. It often requires strong attention to detail, communication skills, and the ability to handle difficult customer interactions, which can contribute to job-related stress.

What does an insurance claims processing do?

An insurance claims processor reviews and evaluates insurance claims to determine coverage and payout amounts. They verify policy details, gather necessary documentation, and ensure claims are processed accurately and efficiently, often using claims management software. Attention to detail and knowledge of insurance policies are essential for this role.

What are popular job titles related to Insurance Claims Processing jobs in New Jersey?

For Insurance Claims Processing jobs in New Jersey, the most frequently searched job titles are:

What job categories do people searching Insurance Claims Processing jobs in New Jersey look for?

The top searched job categories for Insurance Claims Processing jobs in New Jersey are:

Insurance Claims Processing jobs near you
Infographic showing various Insurance Claims Processing job openings in New Jersey as of August 2026, with employment types broken down into 81% Full Time, 15% Part Time, and 4% Contract. Highlights an 96% In-person, and 4% Hybrid job distribution.

Claims A/R and Denial Analyst Escalations - CPC Lead

Allied Digestive Health

West Long Branch, NJ • On-site

$35 - $38/hr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 12 days ago

Allied Digestive Health rating

8.0

Company rating: 8.0 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

Job description

We are hiring for a Claims A/R and Denial Analyst Escalations – CPC Lead at our Central Business Office in West Long Branch, NJ

Summary:

This position requires strong expertise in coding guidelines, payer policy, denials management, and claims processing. The Claims CPC A/R and Denial Analyst Escalations Lead will serve as a subject-matter expert on denied-claim escalations, contribute to denial-prevention strategies, perform chart reviews, and ensure claims are properly adjudicated for payment. The role supports complex A/R projects, denial coding reviews, and compliance audits while maintaining productivity and quality standards aligned with regulatory and organizational requirements.

Essential Responsibilities:

The responsibilities of the Claims A/R and Denial Analyst Escalations – CPC Lead will include:

• Serve as subject matter expert (SME) for escalated claim denials from vendors and internal RCM teams.

• Master claim denials and claims processing to support denial prevention strategies and drive claim resolution to payment.

• Review coding-related denials for potential correction and resubmission.

• Work assigned high-level A/R projects and complex claim investigations.

• Maintain adherence to quality and productivity standards established by the organization and industry guidelines.

• Follow up on escalated or project-related claims, working no fewer than 65–70 claims per day.

• Identify denial and payer trends and communicate findings to AR management and senior leadership.

• Conduct follow-up with Medicare and Commercial insurance payers on escalated claims.

• Perform coding, billing, and documentation compliance audits within established timelines.

• Assist in identifying the need for payer policy updates or process changes to support regulatory compliance and claim payment.

• Prepare reports summarizing audit findings and recommendations for operational improvement.

• Participates in special projects as assigned.

• Any other duties as assigned.


Essential Skills:

The Claims A/R and Denial Analyst Escalations – CPC Lead must be extremely detail oriented. The Claims A/R and Denial Analyst Escalations – CPC Lead must be able to comprehend all issues and be able to articulate those issues to any involved person(s) needed to assist in their complete resolution.

Education and Experience Required:

CPC, CPB or AHIMA associates degree

• 5+ years Revenue Cycle Management experience

• Strong understanding of CPT, HCPCS, and charge capture workflows

• Experience with Athena, Epic, or comparable PM/EHR systems


We offer competitive base salary, generous benefits, including Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.


Monday-Friday 8:30am-5:00pm

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