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Medical Claims Assessor Jobs (NOW HIRING)

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

DATAMARK (Texas)

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

Judi Health

Claims Adjudication Associate

Charlotte, NC · Hybrid

$17.25 - $23.50/hr

Review, assess, and make decisions on medical claims submitted by networks, claimants, or other parties. * Provide support to Customer Care representatives in relation to claims and benefits ...

ICONMA

Claims processor

$17.50 - $22/hr

Analyze medical claims and supporting documentation to determine eligibility and payment amounts based on provided SOPs. * Conduct thorough evaluations of claims to assess legitimacy while meeting ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Review, assess, and make decisions on medical claims submitted by networks, claimants, or other parties. * Provide support to Customer Care representatives in relation to claims and benefits ...

Judi Health

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Review, assess, and make decisions on medical claims submitted by networks, claimants, or other parties. * Provide support to Customer Care representatives in relation to claims and benefits ...

Arkansas Blue Cross

Claims Specialist I

OR minimum one (1) year of related office experience such as claims processing, health insurance, or medical office. Must pass company proficiency test: Claims Assessment ESSENTIAL SKILLS & ABILITIES ...

Capital Rx

Claims Adjudication Associate

Charlotte, NC · On-site

$82K - $103K/yr

Review, assess, and make decisions on medical claims submitted by networks, claimants, or other parties. * Provide support to Customer Care representatives in relation to claims and benefits ...

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Medical Claims Assessor information

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$5

$16

$18

How much do medical claims assessor jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for medical claims assessor in the United States is $16.83, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $18.27 per hour, depending on experience, location, and employer.

What does a medical claims assessor do?

A Medical Claims Assessor reviews and evaluates insurance claims related to medical treatments and procedures. They assess the validity of claims by examining medical records, policy documents, and other relevant information to determine if the claim meets the policy’s terms and conditions. Their job is to ensure that legitimate claims are paid out efficiently while identifying and preventing fraudulent or ineligible claims. Medical Claims Assessors work closely with healthcare providers, insurance policyholders, and other professionals to resolve claims fairly and accurately.

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

To thrive as a Medical Claims Assessor, you need a solid understanding of medical terminology, insurance policies, and claims processing, typically backed by a relevant diploma or experience in healthcare or insurance. Familiarity with claims management software, coding systems like ICD-10, and regulatory compliance tools is essential. Attention to detail, analytical thinking, and effective communication are critical soft skills for accurately evaluating claims and interacting with stakeholders. These skills ensure precise claim assessments, reduce errors, and maintain trust between insurers, healthcare providers, and clients.

What are some common challenges medical claims assessors face when evaluating claims, and how can they be managed?

Medical Claims Assessors often encounter challenges such as interpreting complex medical terminology, ensuring claims comply with policy terms, and detecting potential fraud. Managing these challenges requires strong attention to detail, ongoing training in medical coding and insurance regulations, and effective communication with healthcare providers. Collaborating with medical professionals and using specialized claims management software can streamline the assessment process and help maintain accuracy.

What is the difference between Medical Claims Assessor vs Medical Claims Processor?

AspectMedical Claims AssessorMedical Claims Processor
Required CredentialsRelevant certifications (e.g., insurance, healthcare)Similar certifications, often including insurance or healthcare knowledge
Work EnvironmentOffice-based, insurance companies, healthcare providersOffice or remote, insurance companies, healthcare organizations
Employer & Industry UsageInsurance firms, healthcare insurers, third-party administratorsInsurance companies, healthcare providers, third-party administrators
Common Search & ComparisonYesYes

The main difference between a Medical Claims Assessor and a Medical Claims Processor lies in their roles. Assessors evaluate claims for validity and coverage, often making decisions on approval or denial. Processors handle the administrative tasks of submitting, updating, and managing claims. Both roles require similar credentials and are found within insurance and healthcare sectors, but assessors focus on evaluation, while processors focus on administrative processing.

How to be a medical claims assessor?

To become a medical claims assessor, candidates typically need a background in healthcare, insurance, or related fields, along with strong analytical and communication skills. Relevant certifications, such as a claims or insurance qualification, can enhance employability. The role often involves reviewing medical documents, assessing claim validity, and using claims management software.

How to become a medical claims assessor?

To become a medical claims assessor, candidates typically need a background in healthcare, insurance, or related fields, along with strong analytical and communication skills. Relevant qualifications include a diploma or degree in health administration, insurance, or a related discipline, and some employers may require industry-specific certifications such as the Certified Claims Professional (CCP). Gaining experience through entry-level roles in claims processing or customer service can also be beneficial.

Is claims processing a stressful job?

Medical Claims Assessors often find claims processing to be a demanding task due to strict deadlines, detailed documentation, and the need for accuracy. The role requires strong attention to detail and the ability to handle high volumes of claims, which can contribute to work-related stress, especially during busy periods or complex cases.
More about Medical Claims Assessor jobs

What states have the most Medical Claims Assessor jobs?

States with the most job openings for Medical Claims Assessor jobs include:

What job categories do people searching Medical Claims Assessor jobs look for?

The top searched job categories for Medical Claims Assessor jobs are:

Medical Claims Assessor jobs near you
Infographic showing various Medical Claims Assessor job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $35,000 per year, or $16.8 per hour.

Medical Claims Processor

Datamark, Inc.

El Paso, TX • On-site

$16.50/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 6 days ago

Job description

Join the DATAMARK, Inc. Team as a Medical Claims Processor!
Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that requires critical thinking and strong judgment? If so, we have the perfect role for you! As a Medical Claims Processor at DATAMARK, you'll play a vital role in the success of our operations by ensuring accurate and efficient back-office support.
We are seeking a detail-oriented and performance-driven Medical Claims Processor to support patients prescribed complex and high-cost drug therapies. In this role, you will be responsible for verifying insurance coverage, conducting research, and resolving coverage-related issues to ensure timely and accurate prescription processing.
This is a back-office position that requires strong analytical skills, efficiency, and comfort with outbound calls to insurance providers and patients.
  • Verify insurance coverage for new and existing patients to support timely prescription fulfillment
  • Pull and review customer accounts to assess eligibility, benefits, and coverage limitations
  • Conduct detailed research across multiple systems and portals
  • Initiate and complete outbound calls (OB calls) to insurance companies, pharmacies, and other partners to resolve coverage issues
  • Accurately document findings, decisions, and next steps in internal systems
  • Meet or exceed productivity expectations while maintaining accuracy
  • Identify and escalate complex cases or discrepancies as appropriate
  • Support patients requiring specialty, high-cost, or complex therapies through thorough and timely insurance determination

Requirements
  • Previous experience in insurance verification, benefits investigation, pharmacy operations, or healthcare administration preferred
  • Knowledge of medical insurance terminology (deductibles, copays, prior authorizations, etc.)
  • Strong attention to detail and ability to process high volumes of information accurately
  • Excellent reading comprehension and research abilities
  • Comfortable making outbound calls to resolve insurance or coverage-related issues
  • Strong problem-solving and critical-thinking skills
  • Ability to manage productivity metrics in a fast-paced environment
  • Basic computer proficiency and experience navigating multiple systems

Benefits
  • Health Care Plan (Medical, Dental & Vision)
  • Retirement Plan (401k, IRA)
  • Life Insurance (Basic, Voluntary & AD&D)
  • Paid Time Off
  • Short Term & Long Term Disability
  • Training & Development
  • Wellness Resources
  • $16.50 per hour

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