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Insurance Claims Processing Jobs in Pennsylvania

Sovereign Insurance Group

Claims Specialist

Berwyn, PA · On-site

$80K - $100K/yr

This person in this position works closely with customers and insurance carriers, providing support and guidance to ensure a seamless experience throughout the claims process. Responsibilities

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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 Pennsylvania?

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

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

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

What cities in Pennsylvania are hiring for Insurance Claims Processing jobs?

Cities in Pennsylvania with the most Insurance Claims Processing job openings:

Insurance Claims Processing jobs near you
Infographic showing various Insurance Claims Processing job openings in Pennsylvania as of August 2026, with employment types broken down into 1% As Needed, 70% Full Time, 25% Part Time, and 4% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution.

Claims Processing Specialist - Tarentum, PA

Tarentum, PA • On-site

Blackburn's
Retail • 11 - 50 employees
Learn more about Blackburn'sexternal

Other

Re-posted 20 hours ago

Job description

Claims Processing Specialist

Blackburn's Corporate - Tarentum, PA 15084

Overview: Category Insurance

Insurance Claims Specialist - DME/HME

Location: Tarentum, PA Department: Claims

At Blackburn's Physicians Pharmacy, we help patients gain access to the medical equipment and healthcare services they depend on every day. We are currently seeking an experienced Insurance Claims Coordinator to join our Claims team and support the processing, follow-up, and resolution of medical insurance claims within a fast-paced DME/HME environment.

This position is ideal for someone who is highly organized, detail-focused, and comfortable working with insurance documentation, billing systems, and payer communications.

About the Role

The Claims Specialist is responsible for reviewing and processing healthcare claims, tracking insurance requirements, and supporting reimbursement efforts for medical equipment and related services. This role works closely with internal departments, insurance companies, and healthcare providers to ensure claims are handled accurately and efficiently.

The right candidate will be proactive, dependable, and able to manage multiple priorities while maintaining a high level of accuracy.

Responsibilities
  • Review and process medical insurance claims in accordance with payer guidelines
  • Monitor claim status and perform follow-up on outstanding or denied claims
  • Verify documentation requirements and ensure records are complete before submission
  • Assist with insurance authorizations, reauthorizations, and prescription renewals
  • Communicate with insurance representatives regarding claim status, missing information, or denials
  • Work collaboratively with billing teams, customer service staff, and clinical departments
  • Maintain accurate account notes and supporting documentation
  • Prioritize daily workloads to meet filing deadlines and departmental goals
  • Identify recurring issues and help support process improvements to reduce delays and denials
  • Ensure compliance with company procedures and insurance regulations
What We Offer
  • Stable, full-time position with a growing healthcare organization
  • Supportive team environment with hands-on training
  • Opportunities for advancement and professional development
  • Competitive pay and benefits package
  • The opportunity to make a direct impact on patient care and service
Qualifications

What We're Looking For:

  • Previous experience in healthcare billing, claims processing, DME/HME, or insurance coordination preferred
  • Understanding of Medicare, Medicaid, and commercial insurance processes is a plus
  • Strong attention to detail and problem-solving skills
  • Excellent communication and organizational abilities
  • Ability to work independently and as part of a team
  • Comfortable working in a high-volume, deadline-driven environment
  • Basic proficiency with Microsoft Office and computer-based systems

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