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Medical Claims Analyst Jobs (NOW HIRING)

Searhc

Medical Claims Analyst

Juneau, AK

$31.83 - $44.56/hr

Pay Range:$31.83 - $44.56 The Medical Claims Analyst is responsible for supporting the accuracy, completeness, and compliance of medical claims processing and related Purchased/Referred Care (PRC ...

Integrated Resources INC

Claims Analyst

Syracuse, NY · On-site

Conducts analysis around various claims payment processes to ensure accuracy of system ... Looking for medical claims experience for these position. * Top Three: Claims knowledge, efficient ...

Professional Healthcare Solutions, LLC

Be Seen First

RN/Medical Claims Analyst

Houston, TX · Remote

$32.50 - $34/hr

Responsibilities may include additional research on medical claims data and other sources of information to identify problems and utilize a variety of tools to detect situations of potential fraud ...

Next Step Systems

Medical Claims Coder

Tucson, AZ · On-site

Medical Claims Coder, Tucson, AZ Under general supervision from the Director of Operations, the ... Conduct research and analysis of claims; facilitate resolution of specific claims issues. Monitor ...

Next Step Systems

Medical Claims Coder

Tucson, AZ · On-site

Medical Claims Coder, Tucson, AZ The Medical Claims Coder needs experience with ICD-10, Current ... Conduct research and analysis of claims; facilitate resolution of specific claims issues. Monitor ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ Under general supervision from the Director of Operations, the ... Conduct research and analysis of claims; facilitate resolution of specific claims issues. Monitor ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

The Medical Claims Examiner is also responsible for monitoring copays, deductibles, insurance verification, and authorizations, analyzing incoming and outgoing revenue sources and measuring different ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ The Medical Claims Examiner needs experience with ICD-10, ... Conduct research and analysis of claims; facilitate resolution of specific claims issues. Monitor ...

Delaware Claims

Claims Analyst

Wilmington, DE · On-site

$52K/yr

... package includes medical, dental, vision, disability, parking stipend, 401-K, generous PTO ... Duties Analyze Claims in accordance with Review procedures. Take a proactive approach to claims ...

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Medical Claims Analyst information

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How much do medical claims analyst jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for medical claims 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 Claims Analyst Do?

As a medical claims analyst, your responsibilities revolve around healthcare reimbursement, where you audit medical claims to ensure company reimbursement payments are accurate and reprice claims according to hospital payment schedules and Medicare reimbursement, which can be done manually or using computer software. You monitor electronic claims utilizing a processing system and provide detailed reporting on data such as claims volume, savings, and billed charges. You are expected to provide excellent customer service when working with customers and hospitals to resolve insurance claim issues, answer questions, and provide solutions to other problems related to medical claims. Other duties include abiding by all healthcare industry policies and regulations, staying updated on changing laws, and collaborating with the claims team to identify process gaps and improve your procedures.

What does a Medical Claims Analyst do?

A Medical Claims Analyst reviews and processes medical insurance claims submitted by healthcare providers or patients. Their main role is to ensure claims are accurate, complete, and comply with policy guidelines and regulations. They investigate discrepancies, verify patient and provider information, and determine the amount of coverage or reimbursement. Additionally, they may communicate with healthcare providers, insurance companies, and patients to resolve issues or request additional information. Their work helps prevent fraud and ensures that claims are paid correctly and efficiently.

What are some common challenges faced by Medical Claims Analysts and how can they be addressed?

Medical Claims Analysts often encounter challenges such as interpreting complex medical codes, identifying discrepancies in claims, and navigating frequent changes in insurance policies and regulations. Staying current with coding standards (like ICD-10 and CPT) and maintaining strong attention to detail are crucial for accuracy. Effective communication with healthcare providers and insurance companies also helps resolve ambiguities quickly. Regular training and collaboration with experienced colleagues can further enhance problem-solving skills and adaptability in this dynamic role.

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

To thrive as a Medical Claims Analyst, you need a solid understanding of medical terminology, health insurance policies, and claims processing, often supported by a degree in healthcare administration or a related field. Familiarity with claims management software, medical coding systems (such as ICD-10 and CPT), and sometimes certification like Certified Professional Coder (CPC) is typically required. Attention to detail, analytical thinking, and effective communication are vital soft skills for accurately reviewing and processing claims. These skills ensure the correct adjudication of claims, minimize errors or fraud, and contribute to efficient healthcare reimbursement processes.

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

AspectMedical Claims AnalystMedical Billing Specialist
CredentialsTypically requires a certification like CPC or CCSOften requires certification but less frequently
Work EnvironmentInsurance companies, healthcare providers, or third-party administratorsMedical offices, clinics, or billing companies
Job FocusAnalyzing and processing insurance claims, ensuring accuracyPreparing and submitting patient bills, following up on payments
Common UsageUsed in insurance and healthcare administrationUsed in healthcare provider billing departments

While both roles involve handling healthcare financial processes, Medical Claims Analysts focus on reviewing and processing insurance claims for accuracy and reimbursement, often requiring analytical skills and certifications. Medical Billing Specialists primarily handle the creation and submission of patient bills and follow-up, emphasizing billing procedures and customer service. Understanding these differences helps job seekers identify the right career path in healthcare finance.

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Medical Claims Analyst jobs near you
Infographic showing various Medical Claims Analyst job openings in the United States as of July 2026, with employment types broken down into 89% Full Time, 6% Part Time, 1% Temporary, and 4% Contract. Highlights an 83% Physical, 7% Hybrid, and 10% Remote job distribution, with an average salary of $52,237 per year, or $25.1 per hour.

Medical Claims Analyst

Southeast Alaska Regional Health Consortium

Juneau, AK • On-site

$31.83 - $44.56/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 11 days ago

Southeast Alaska Regional Health Consortium rating

8.0

Company rating: 8.0 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Pay Range:
Pay Range:$31.83 - $44.56The Medical Claims Analyst is responsible for supporting the accuracy, completeness, and compliance of medical claims processing and related Purchased/Referred Care (PRC) activities across the organization. This role performs claims review and processing, eligibility verification, referral validation, payment research, system administration, workflow support, and data integrity monitoring to ensure authorized services are processed accurately and timely. The position partners with PRC leadership, Finance, providers, internal departments, and external vendors to resolve complex claims issues, support reporting needs, improve claims processing workflows, and strengthen operational performance. Additionally, the role supports training, special projects, system upgrades, audit preparation, policy updates, and process improvement initiatives that advance PRC program compliance, provider communication, and financial decision-making.
SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.
Key Essential Functions and Accountabilities of the Job
  • Performs all duties of the Medical Claims Specialist role, including review, screening, eligibility verification, alternate health resource verification, referral validation, claim processing, claims research, customer service, and interpretation of PRC Program regulations, policies, and procedures for internal and external customers.
  • Serves as the system administrator for the PRC claims processing platform, including user access coordination, system configuration support, workflow maintenance, issue tracking, testing, troubleshooting, and coordination with internal departments and external vendors as needed.
  • Maintains data integrity within the claims processing system by monitoring claim data, validating system outputs, supporting timely correction of errors, and identifying opportunities to improve accuracy, efficiency, and consistency in claims processing workflows.
  • Develops and supports training for providers, PRC staff, internal departments, and other key stakeholders on claims submission requirements, claims status processes, system workflows, documentation expectations, and applicable PRC policies and procedures.
  • Supports reporting projects for finance leadership and the executive team by gathering, validating, analyzing, and summarizing claims data, utilization trends, outstanding liabilities, denial activity, payment status, and other information needed for operational, financial, and strategic decision-making.
  • Partners with PRC leadership, Finance, providers, and other stakeholders to resolve complex claims issues, improve claims processing workflows, support provider communication, and ensure accurate and timely payment of authorized services.
  • Assists with special projects, process improvement initiatives, system upgrades, audit support, policy updates, and other duties as assigned.

Additional Job Description
Education, Certifications, and Licenses Required
  • High school diploma or equivalent required.
  • Medical terminology course required or 1 year of documented experience in a medical field requiring consistent use of medical terminology.
  • Bachelors degree in health care administration, business, finance, information systems, or related field preferred.

Experience Required
  • 2 years of data entry experience with basic knowledge of accounts payable processing, MS Excel, and MS Word software applications.
  • 4 years of business, medical office, claims processing, revenue cycle, health care finance, or related experience OR an equivalent combination of education and experience.
  • Experience processing medical claims in a tribal health organization preferred.
  • Experience with claims processing systems, system administration, reporting, training, workflow support, or process improvement preferred.
  • Medical coding background preferred.

Knowledge of
  • State, federal, and tribal health care programs.
  • Medical insurance process.
  • PRC Program regulations, policies, and procedures.
  • ICD, CPT, revenue, and diagnosis coding.
  • Claims processing systems, data entry standards, workflow controls, and system integrity practices.
  • Basic reporting concepts, data validation, and financial or operational analysis.

Skills in
  • Interpreting state, federal, and tribal contract health care guidelines.
  • Research, problem solving, claims analysis, and issue resolution.
  • Using claims processing systems, MS Excel, MS Word, and related reporting tools.
  • Training, presenting information, and communicating technical or process information to providers, staff, and other stakeholders.
  • Oral/written interpersonal communication and excellent customer service skills.

Ability to
  • Ability to multitask and manage competing priorities.
  • Ability to enter, review, and analyze large volumes of data timely and accurately.
  • Ability to work independently with minimal supervision and exercise sound judgment in resolving claims and system-related issues.
  • Ability to support users, troubleshoot workflow issues, and coordinate system-related follow-up with internal and external stakeholders.
  • Ability to prepare clear, accurate, and timely reporting to support finance leadership and executive decision-making.
  • Ability to respond quickly in urgent situations with attention to detail.

Required Certifications:
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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