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Medicaid Claims Jobs (NOW HIRING)

GDIT

Medicaid Claims Operations Manager

Montgomery, AL · Hybrid

Claims Operations, Healthcare Claims Processing, Medicaid Claims, Medicaid Policy, People Management Certifications: None Experience: 5 + years of related experience US Citizenship Required: No At ...

Sweetwater Care

Medicaid Specialist

Boston, MA · On-site

Claims Processing and Billing: You will be responsible for processing and billing Medicaid claims, ensuring accurate and timely submission to minimize delays and denials. * Patient Advocacy: You will ...

BerryDunn

Claims Data Analyst

Kapolei, HI

Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to identify trends, risks, anomalies, billing patterns, and opportunities for operational ...

BerryDunn

Claims Data Analyst

Kapolei, HI · On-site

Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to identify trends, risks, anomalies, billing patterns, and opportunities for operational ...

BerryDunn

Claims Data Analyst

Kapolei, HI · On-site

Analyze Medicaid claims, provider, member, utilization, financial, program integrity, and FWA-related data to identify trends, risks, anomalies, billing patterns, and opportunities for operational ...

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Medicaid Claims information

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How much do medicaid claims jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for medicaid claims 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 are Medicaid claims?

Medicaid claims are requests for payment submitted by healthcare providers to state Medicaid programs for services rendered to Medicaid beneficiaries. These claims detail the medical services provided, the dates of service, and the costs involved. The state Medicaid agency reviews these claims to ensure they meet program requirements before reimbursing the provider. Proper submission and documentation are essential to avoid claim denials and ensure timely payment.

What are the key skills and qualifications needed to thrive as a Medicaid claims specialist?

To thrive as a Medicaid Claims Specialist, you need a detailed understanding of Medicaid policies, medical billing and coding, and claims processing procedures, often supported by relevant certification or experience in healthcare administration. Familiarity with claims management software, electronic health record (EHR) systems, and ICD/CPT coding tools is typically required. Strong analytical skills, attention to detail, and effective communication help you resolve claim discrepancies and collaborate with providers. These skills are critical to ensuring accurate claim submissions, timely reimbursements, and compliance with healthcare regulations.

What are some common challenges faced by professionals working in Medicaid claims processing?

Professionals in Medicaid Claims often grapple with staying current on frequently changing regulations and payer requirements, which can impact claim accuracy and reimbursement timelines. Additionally, the role requires careful attention to detail when reviewing documentation and coding to prevent denials or delays in payment. Working closely with healthcare providers, billing staff, and insurance representatives is common, making strong communication and problem-solving skills essential for resolving discrepancies and ensuring efficient claims resolution.

What is the difference between Medicaid Claims vs Medicaid Billing Specialist?

AspectMedicaid ClaimsMedicaid Billing Specialist
CredentialsKnowledge of Medicaid policies, basic coding skillsSame as Medicaid Claims, often with additional billing certifications
Work EnvironmentHealthcare facilities, insurance companies, government agenciesMedical offices, billing companies, healthcare providers
Job FocusProcessing and submitting Medicaid claims for reimbursementManaging entire billing process, including claims, payments, and denials
Common UsageInvolved in claims submission and follow-upOversees billing cycle, ensures accurate reimbursement

While both roles involve Medicaid-related financial processes, Medicaid Claims focuses specifically on submitting and managing claims, whereas Medicaid Billing Specialist handles the broader billing process, including payments and denials. Both positions require knowledge of Medicaid policies and coding, but the Billing Specialist often has additional responsibilities in managing the entire billing cycle.

How do I become a Medicaid Claims specialist?

To become a Medicaid Claims specialist, typically one needs a high school diploma or equivalent, with some roles requiring postsecondary education or certifications in healthcare administration or medical billing. Relevant skills include knowledge of Medicaid policies, medical coding, and claims processing software; experience in healthcare billing or claims management is also beneficial.
More about Medicaid Claims jobs

What states have the most Medicaid Claims jobs?

States with the most job openings for Medicaid Claims jobs include:

What job categories do people searching Medicaid Claims jobs look for?

The top searched job categories for Medicaid Claims jobs are:

Medicaid Claims jobs near you
Infographic showing various Medicaid Claims job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 82% Physical, 5% Hybrid, and 13% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.

Medicaid Claims Examiner

Coral Gables, FL • On-site

DOCTORS HEALTHCARE PLANS, INC.
Health Care and Social Assistance • 51 - 200 employees
Learn more about DOCTORS HEALTHCARE PLANS, INC.external

Full-time

Medical

Posted 7 days ago

Job description

Position Purpose: The Medicaid Claims Examiner is responsible for reviewing, analyzing, processing, and adjudicating Medicaid claims to ensure compliance with federal and state regulations, provider contracts, and health plan policies. The examiner investigates claim discrepancies, resolves pended claims, and ensures accurate and timely reimbursement while maintaining high standards of quality and productivity.
Essential Duties and Responsibilities:
  • Review and process Medicaid professional, institutional, and ancillary claims.
  • Analyze claims for completeness, accuracy, medical necessity, and policy compliance.
  • Apply Medicaid benefits, provider contract provisions, fee schedules, and reimbursement methodologies.
  • Research and resolve claim edits, denials, suspensions, and payment discrepancies.
  • Verify member eligibility, authorization requirements, coordination of benefits (COB), and third-party liability information.
  • Interpret and apply CMS, state Medicaid, and health plan guidelines during claims adjudication.
  • Communicate with providers, internal departments, and vendors to obtain missing or clarifying information.
  • Inter-department collaboration for timely Medicaid encounter remediation and resubmission to the State.
  • Management and remediation of Medicaid encounter rejections
  • Collaborating with provider relations and other departments, as necessary for timely encounter resubmission to the Agency for Healthcare Administration
  • Maintain accurate documentation of claim determinations and adjustments.
  • Meet departmental productivity, accuracy, and turnaround-time standards.
  • Participate in audits, quality reviews, and process improvement initiatives.
Required Qualifications:
  • High School Diploma or GED required; Associate's or Bachelor's degree preferred.
  • 1-3 years of healthcare claims processing experience; Medicaid experience preferred.
  • Knowledge of medical terminology, CPT, HCPCS, ICD-10, revenue codes, and billing practices.
  • Understanding of Medicaid regulations, CMS guidelines, and managed care operations.
  • Proficiency with claims processing systems and Microsoft Office applications.
  • Strong analytical, organizational, and problem-solving skills.
  • Excellent verbal and written communication skills.

Preferred Qualifications:
  • Experience with Medicaid Managed Care Organizations (MCOs).
  • Familiarity with provider contracts and reimbursement methodologies.
  • Knowledge of coordination of benefits (COB), subrogation, and fraud, waste, and abuse (FWA) principles.

Note: This description indicates, in general terms, the type and level of work performed and responsibilities held by the team member(s). Duties described are not to be interpreted as being all-inclusive or specific to any individual team member.
No Third Party Agencies or Submissions Will Be Accepted.
Our company is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. DFWP
Opportunities posted here do not create any implied or express employment contract between you and our company / our clients and can be changed at our discretion and / or the discretion of our clients. Any and all information may change without notice. We reserve the right to solely determine applicant suitability. By your submission you agree to all terms herein.

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