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Medicaid Claims Processor Jobs (NOW HIRING)

CYNET SYSTEMS

Medicaid Claims Analyst

Parsippany, NJ · On-site

$55 - $60/hr

Responsible for processing, validating, analyzing, and resolving Medicaid claims while ensuring compliance with Medicaid regulations, rebate systems, and data accuracy standards. Experience: * Prior ...

Memorial Health

Medicaid Specialist

Springfield, IL · On-site

$18.34 - $28.42/hr

Prioritizes claims based on specified criteria and electronically files the claim, ensuring careful adherence to Medicaid guidelines, timeliness, accuracy, and processing procedures. At prescribed ...

Memorial Health

Medicaid Specialist

Springfield, IL · Remote

$18.34 - $28.42/hr

Prioritizes claims based on specified criteria and electronically files the claim, ensuring careful adherence to Medicaid guidelines, timeliness, accuracy, and processing procedures. At prescribed ...

Memorial Health

Medicaid Specialist

Springfield, IL · Remote

$18.34 - $28.42/hr

Prioritizes claims based on specified criteria and electronically files the claim, ensuring careful adherence to Medicaid guidelines, timeliness, accuracy, and processing procedures. At prescribed ...

OmegaHires

Medicaid Data Architect

Austin, TX · On-site

$63.25 - $81.25/hr

... Medicaid Claims Processing. Responsibilities : • Collaborating with business and technical stakeholders to analyze, develop, and test system enhancements within a government agency environment ...

Moda Health

Inpatient Claims Processor I

Milwaukie, OR · On-site

Position Summary Responsible for timely and accurate payment of Commercial and Medicaid inpatient ... High School diploma or equivalent. * 1-2 years medical claims processing experience. * 10-key ...

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Medicaid Claims Processor information

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How much do medicaid claims processor jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for medicaid claims processor in the United States is $19.16, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.67 per hour, depending on experience, location, and employer.

Is a claims processor job in demand?

Medicaid claims processor jobs are in demand due to the ongoing need for healthcare administration and insurance processing. The role often requires attention to detail and familiarity with claims processing software, and employment opportunities are expected to grow as healthcare programs expand and evolve.

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

AspectMedicaid Claims ProcessorMedical Billing Specialist
CredentialsHigh school diploma; some roles may require certificationHigh school diploma; certification often preferred
Work EnvironmentHealthcare facilities, government agencies, insurance companiesMedical offices, clinics, healthcare organizations
Job FocusProcessing Medicaid claims, verifying eligibility, ensuring complianceBilling, coding, submitting claims, managing accounts receivable

Medicaid Claims Processors primarily focus on reviewing and processing Medicaid claims to ensure accurate reimbursement, often working within government or insurance settings. Medical Billing Specialists handle a broader range of billing tasks across healthcare providers, including coding and managing patient accounts. While both roles require knowledge of healthcare billing and insurance procedures, Medicaid Claims Processors specialize in Medicaid-specific claims processing, making them distinct in their focus and work environment.

What does a Medicaid Claims Processor do?

A Medicaid Claims Processor reviews, evaluates, and processes medical claims submitted by healthcare providers to ensure they comply with Medicaid guidelines. They verify patient eligibility, check claim accuracy, and determine the appropriate reimbursement based on state and federal regulations. This role often involves data entry, communication with providers for additional information, and resolving discrepancies to ensure timely and correct payments. Their work helps ensure that healthcare providers are properly compensated while preventing fraud and abuse within the Medicaid system.

What jobs pay 2000 a day?

Medicaid Claims Processors typically do not earn $2,000 a day; their salaries are usually based on hourly wages or salaries. High-paying jobs that can reach or exceed $2,000 daily often include specialized roles such as surgeons, anesthesiologists, or senior executives, which require advanced skills, certifications, and experience. These roles are generally found in healthcare, finance, or executive management sectors and may involve long hours or high responsibility levels.

How much do claims processors make in the US?

Medicaid claims processors in the US typically earn between $35,000 and $50,000 annually, depending on experience, location, and employer. Entry-level positions may start lower, while experienced processors with certifications can earn higher salaries, often working in office environments with standard business hours.

What are some common challenges faced by Medicaid Claims Processors and how can they be managed?

Medicaid Claims Processors often encounter challenges such as interpreting complex regulations, accurately coding claims, and handling high volumes of paperwork within tight deadlines. Staying updated on policy changes and utilizing claims management software can help mitigate errors and improve efficiency. Regular collaboration with healthcare providers and billing departments is also key to resolving discrepancies quickly and maintaining compliance. Adapting to these challenges not only improves job performance but also provides valuable experience for career advancement within healthcare administration.

What are the key skills and qualifications needed to thrive as a Medicaid Claims Processor, and why are they important?

To thrive as a Medicaid Claims Processor, you need strong attention to detail, knowledge of medical billing codes, and familiarity with Medicaid regulations, often supported by a high school diploma or equivalent. Proficiency in claims management software, electronic health records (EHR) systems, and possibly certification in medical billing and coding is typically required. Strong organizational skills, problem-solving abilities, and effective communication are valuable soft skills in this role. These competencies are crucial for accurately processing claims, minimizing errors, and ensuring timely reimbursement and compliance with healthcare regulations.

How do I become a claims processor?

To become a Medicaid claims processor, typically you need a high school diploma or equivalent, and some employers prefer postsecondary education or training in healthcare administration or related fields. Relevant skills include attention to detail, knowledge of medical billing and coding, and familiarity with claims processing software. Certification in medical billing or coding can enhance job prospects, and on-the-job training is often provided.
More about Medicaid Claims Processor jobs
What states have the most Medicaid Claims Processor jobs? States with the most job openings for Medicaid Claims Processor jobs include:
What job categories do people searching Medicaid Claims Processor jobs look for? The top searched job categories for Medicaid Claims Processor jobs are:
Medicaid Claims Processor jobs near you
Infographic showing various Medicaid Claims Processor job openings in the United States as of June 2026, with employment types broken down into 3% As Needed, 81% Full Time, 13% Part Time, and 3% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $39,863 per year, or $19.2 per hour.
Medicaid Claims Analyst

Medicaid Claims Analyst

CYNET SYSTEMS

Parsippany, NJ • On-site

$55 - $60/hr

Contractor

Posted 24 days ago

Job description

Job Overview:
 
Pay Range: $55hr - $60hr
  • Responsible for processing, validating, analyzing, and resolving Medicaid claims while ensuring compliance with Medicaid regulations, rebate systems, and data accuracy standards.

Experience:

  • Prior Medicaid claim processing experience with a pharmaceutical, medical device company, state agency, Medicaid consulting organization, or equivalent work experience.
  • Minimum 2+ years of pharmaceutical or healthcare industry experience preferred.
  • Experience with Medicaid claim processing functions and large dataset management.
  • Experience with negotiation and conflict resolution preferred.
  • Experience with system implementation and report writing preferred.

Responsibilities:

  • Work with assigned states to obtain Medicaid Summary invoices, summary data files, and Claim Level Invoices each quarter.
  • Review received information to ensure completeness and accuracy.
  • Upload data into Medicaid systems and authorize transactions.
  • Document errors, conduct research, and resolve discrepancies.
  • Perform quality checks on claim submissions to ensure rebate eligibility and data consistency.
  • Conduct Claim Level Detail validation and review suspect claim records.
  • Determine if claim records should be disputed for payment and recommend payment resolutions.
  • Resolve disputes related to historical outstanding utilization submitted with Medicaid claims.
  • Apply proper payment amounts and ensure CMS codes are correctly assigned.
  • Notify states regarding findings and claim resolutions.
  • Complete Medicaid analysis and maintain documentation for assigned states and programs.
  • Communicate key findings and program changes to management.
  • Provide backup support for Medicaid team members and contribute to establishing best practices.
  • Analyze processes and systems to improve operational efficiency through standardization and automation.
  • Build and maintain strong relationships with internal and external stakeholders.
  • Manage multiple priorities while meeting deadlines and organizational objectives.

Should Have:

  • Strong analytical and data interpretation skills.
  • Strong organizational and prioritization skills.
  • High attention to detail and accuracy in data processing.
  • Ability to work independently and make recommendations on disputes and payment resolutions.
  • Strong interpersonal and communication skills.
  • Ability to coach and collaborate effectively within a team environment.

Skills:

  • Knowledge of Model N, Revitas/Flex Medicaid, Flex Validata, or similar Medicaid systems.
  • Advanced Microsoft Excel and data management skills.
  • Familiarity with CMS Medicaid rules and state-specific Medicaid regulations.
  • Knowledge of Medicaid validation rules and 340B covered entity issues.
  • Strong accounting and internal control knowledge.
  • Data analysis and reporting skills.
  • Understanding of rebate systems and government pricing processes.

Qualification And Education:

  • Bachelor’s degree or equivalent combination of experience, training, and related work experience.
  • Medicaid, government pricing, and pharmaceutical industry knowledge preferred.

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading staffing and recruiting powerhouse. Proudly recognized as a nationally and locally certified diversity firm, Cynet delivers agile, scalable talent solutions across industries. With an active footprint in all 50 U.S. states and Canada, we support thousands of consultants through our expansive, high-performing recruitment engine operating across North America and Asia—ensuring speed, quality, and consistency in every hire.
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About Cynet Systems

Sourced by ZipRecruiter

Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.

Industry

It services

Company size

501 - 1,000 Employees

Headquarters location

Sterling, VA, US

Year founded

2010

Social media

Twitter

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