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Medical Claim Analyst Jobs (NOW HIRING)

CVS Health

Medical Claim Analyst

$18.50 - $38.82/hr

... analyst role is integral to the CCR team. -They start the CCR process with the claim submission to ... Medical Directors as required. -Review provider and member claims to determine if they meet CCR ...

Secure Eclaims LLC

Medical Claim Analyst

Miami, FL · On-site

* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...

Secure Eclaims LLC

Medical Claim Analyst

Miami, FL

* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...

Principal Financial Group

Claim Analyst 3

Des Moines, IA · On-site +1

$22.93 - $40.96/hr

Analyze medical, vocational, and financial information to make effective and timely claim decisions. This includes having an in-depth knowledge of claim procedures, product design, contract ...

Principal Financial Group

Claim Analyst 3

Des Moines, IA · On-site +1

$30.58 - $40.96/hr

Analyze medical, vocational, and financial information to make effective and timely claim decisions. This includes having an in-depth knowledge of claim procedures, product design, contract ...

Dearborn Group

Sr Claims Analyst - LHB

Overland Park, KS · On-site +1

High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability ... Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) * Ability to adapt ...

Luminare Health

Sr Claims Analyst - LHB

Overland Park, KS · On-site +1

High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability ... Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) * Ability to adapt ...

Dearborn Group

Sr Claims Analyst - LHB

Overland Park, KS · On-site

High School diploma or GED equivalent * 3 years prior medical claim processing experience * Ability ... Ability to analyze and interpret documents and Summary Plan Descriptions (SPDs) * Ability to adapt ...

The Reny Company

Medical Claim Processor

Plano, TX · On-site

$18.50 - $21/hr

THIS IS NOT A REMOTE POSITION The Reny Company's medical claim processor is a professional who ... Effective analytical and interpersonal skills Company Description The Reny Company is a rapidly ...

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Medical Claim Analyst information

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$15

$25

$41

How much do medical claim analyst jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for medical claim analyst in the United States is $25.11, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.24 per hour, depending on experience, location, and employer.

What does a medical claim analyst do?

A Medical Claim Analyst reviews and processes medical insurance claims submitted by healthcare providers or policyholders. They examine the accuracy and completeness of the claims, verify patient eligibility and coverage, and ensure that the services billed are covered by the insurance policy. Medical Claim Analysts also identify potential errors, discrepancies, or fraudulent activities in claims and communicate with providers or members to resolve issues. Their work helps ensure timely and accurate reimbursement for medical services and maintains the integrity of the claims process.

What are the key skills and qualifications needed to thrive as a medical claim analyst, and why are they important?

To thrive as a Medical Claim Analyst, you need a solid understanding of medical terminology, insurance guidelines, and claims processing, often supported by a relevant associate degree or certification. Familiarity with claims management software, ICD-10/CPT coding systems, and electronic health record (EHR) platforms is typically required. Strong attention to detail, analytical thinking, and effective communication skills help analysts resolve discrepancies and collaborate with healthcare providers. These skills ensure accurate claim evaluations, minimize errors, and contribute to efficient reimbursement processes in healthcare organizations.

What are some common challenges medical claim analysts face when reviewing complex claims?

Medical Claim Analysts often encounter challenges such as interpreting varying coding standards, handling incomplete or ambiguous documentation, and staying updated with constantly changing healthcare regulations. Managing high volumes of claims while ensuring accuracy can also be demanding, especially when claims involve specialized procedures or multi-layered insurance policies. Strong attention to detail, effective communication with providers or patients, and ongoing training help analysts overcome these obstacles and ensure timely, accurate claim processing.

What is the difference between Medical Claim Analyst vs Medical Billing Specialist?

AspectMedical Claim AnalystMedical Billing Specialist
CredentialsTypically requires a certification like CPC or similarOften requires certification but less specialized
Work EnvironmentInsurance companies, healthcare providers, or third-party payersMedical offices, clinics, or billing companies
Job FocusAnalyzing and processing insurance claims, ensuring accuracyPreparing and submitting patient bills, following up on payments

While both roles involve handling healthcare financial transactions, Medical Claim Analysts focus on reviewing and processing insurance claims for accuracy and reimbursement, whereas Medical Billing Specialists primarily prepare and submit patient bills and follow up on payments. Both roles require knowledge of medical coding and insurance policies but differ in their core responsibilities and work settings.

How much do medical claim analysts make in the US?

Medical claim analysts in the US typically earn a median annual salary of around $45,000 to $65,000, depending on experience, location, and certifications. Entry-level positions may start lower, while experienced analysts or those with specialized skills can earn higher salaries, often with opportunities for overtime and bonuses.

How to become a medical claim analyst?

To become a medical claim analyst, typically a high school diploma or equivalent is required, with many employers preferring a bachelor's degree in health administration, finance, or a related field. Relevant skills include knowledge of insurance policies, medical billing, and claims processing software, and some positions may require certification such as the Certified Professional Coder (CPC) or similar credentials.

What is the role of a Medical Claim Analyst?

A Medical Claim Analyst reviews and processes healthcare insurance claims to ensure accuracy, compliance, and proper reimbursement. They analyze medical records, verify billing details, and work with insurance providers to resolve claim discrepancies, often using claims processing software and requiring knowledge of healthcare regulations.
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Medical Claim Analyst jobs near you
Infographic showing various Medical Claim Analyst job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $52,237 per year, or $25.1 per hour.

Medical Claim Analyst

CVS Health

Remote

$18.50 - $38.82/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

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

CVS Health rating

5.8

Company rating: 5.8 out of 10

Based on 4,357 frontline employees who took The Breakroom Quiz

92nd of 113 rated pharmacies

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary
CCR is responsible for post - service claim review to determine if specific
services can be reimbursed to providers and members.
- The analyst role is integral to the CCR team.
-They start the CCR process with the claim submission to CCR with a complete
review of the claim and claim history. They compile all system information,
claim history, plan information, and any additional research into template as
required by the workflow and any legal and regulatory requirements for a
clinician review.
-They also collaborate with Medical Directors as required.
-Review provider and member claims to determine if they meet CCR review requirements.
-Follow applicable workflows, templates, and legal and compliance
requirements to provide a complete picture of what is requiring review to the CCR clinicians and medical directors.
-Organizes and prioritizes work to help meet regulatory and CCR claim turnaround times. Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
-Works with all appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues found in the course of the review.
-Required to work in multiple systems including EWM, ASD, ATV, MedCompass and HRP.
-Other systems dependent on specific reviews criteria.
-Maintains and utilizes all resource materials and systems to effectively manage job responsibilities
Adheres to company policies to protect member
confidentiality.
Required Qualifications
2+ years experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Preferred Qualifications
Knowledge of utilization management rules and regulations and claim processing guidelines.
Claims Processing/ customer service experience preferred


Education Verifiable High School Diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/25/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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