ZipRecruiter

Log In

1

Medical Claims Associate Jobs in Utah (NOW HIRING)

Humana

Appeals Rep

Salt Lake City, UT · On-site

$48K - $65K/yr

Associate Degree or higher * 2 or more years of Grievance & Appeals experience * Medical claims processing experience * Previous inbound call center/customer service experience * Experience with CAS ...

Humana

Code Edit Disputes Medical Coder

Salt Lake City, UT · On-site

$18.25 - $24.25/hr

... claims that contain a code editing related denial or financial recovery. The Medical Coding ... Our Fortune 100 Company values associate engagement & your well-being. We also provide excellent ...

previous pagenext page

Showing results 21-40

All JobsMedical Claims Associate JobsMedical Claims Associate Jobs in Utah

Medical Claims Associate information

What are some common challenges faced by medical claims associates, and how can they be effectively managed?

Medical Claims Associates often encounter challenges such as managing high volumes of claims, navigating complex insurance policies, and ensuring accuracy under tight deadlines. To address these, it's important to develop strong organizational skills, keep up-to-date with the latest policy changes, and utilize available claims processing software efficiently. Additionally, collaborating closely with healthcare providers and insurance representatives can help clarify discrepancies and resolve issues more quickly, making teamwork and communication key assets in this role.

What does a medical claims associate do?

A Medical Claims Associate is responsible for reviewing, processing, and adjudicating medical insurance claims submitted by healthcare providers or policyholders. They verify the accuracy of claims, ensure compliance with insurance policies, and determine the appropriate payment or denial based on guidelines. The role involves communication with healthcare providers, patients, and insurance companies to resolve discrepancies or gather additional information. Medical Claims Associates play a crucial part in ensuring that claims are handled efficiently and accurately, contributing to the smooth operation of healthcare reimbursement processes.

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

AspectMedical Claims AssociateMedical Billing Specialist
CredentialsHigh school diploma; certification often preferredHigh school diploma; certification often preferred
Work EnvironmentHealthcare offices, insurance companiesHealthcare offices, billing companies
Primary ResponsibilitiesReview and process insurance claims, ensure accuracyGenerate bills, submit claims, follow up on payments
Industry UsageInsurance companies, healthcare providersHealthcare providers, billing services

While both roles involve working with healthcare payments, a Medical Claims Associate primarily reviews and processes insurance claims to ensure accuracy and compliance. In contrast, a Medical Billing Specialist focuses on generating bills, submitting claims, and managing payment collections. Both roles require similar credentials and often work in healthcare or insurance settings, but their core functions differ in the claims review versus billing process.

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

To thrive as a Medical Claims Associate, you need strong knowledge of medical terminology, health insurance policies, and claims processing, often supported by a high school diploma or associate degree. Familiarity with claims management software, coding systems like ICD-10 or CPT, and basic office applications is essential. Attention to detail, problem-solving, and effective communication are vital soft skills for accuracy and client interactions. These skills ensure timely, accurate claims processing and help prevent errors or fraud, supporting efficient healthcare operations.

What are the most commonly searched types of Medical Claims jobs in Utah?

The most popular types of Medical Claims jobs in Utah are:

What cities in Utah are hiring for Medical Claims Associate jobs?

Cities in Utah with the most Medical Claims Associate job openings:

Medical Claims Associate jobs near you
Infographic showing various Medical Claims Associate job openings in Utah as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution.

Pharmacy Claims Adjudication Specialist

Onco360

Salt Lake City, UT • Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 112 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity,
Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone.
Full-Time position may work remotely but MUST HAVE ACTIVE UTAH PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documenst and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

What Onco360 employees say

Pay

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply