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Medical Claims Associate Jobs in Virginia (NOW HIRING)

DRG Coding Auditor Principal

Richmond, VA · On-site

$122K - $183K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Analyzes and audits claims by integrating advanced or convoluted medical chart coding principles ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

New

Provider Outreach Business Analyst II

Norfolk, VA

$61K - $92K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience with medical claims processing workflows and related systems preferred. * Experience ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

New

Provider Outreach Business Analyst II

Norfolk, VA

$61K - $92K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience with medical claims processing workflows and related systems preferred. * Experience ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

New

DRG Coding Auditor - MS-DRG and APR-DRG

Norfolk, VA · On-site

$92K - $160K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and ... The health of our associates and communities is a top priority for Elevance Health. We require all ...

Medical Billing

Hampton, VA · On-site

$17 - $19/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Prepare, Review, and transmit claims in Medicaid and other Insurances Billing software * Update and ... High school diploma or equivalent * (associate degree or certification in medical billing/coding ...

Claims Call Centre Representative

Richmond, VA · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Career mobility * Medical, Vision & Dental Basic Qualifications: * High School Diploma or ... Zurich Certified Insurance Apprentice including an Associate Degree and No prior experience ...

Showing results 41-60

Medical Claims Associate information

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 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 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 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 most commonly searched types of Medical Claims jobs in Virginia?

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

Infographic showing various Medical Claims Associate job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 80% In-person, and 20% Remote job distribution.

SIU / Claims Investigator - Northern VA / DC Area

Allied Universal

Winchester, VA

$25 - $32/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago


Allied Universal rating

5.6

Company rating: 5.6 out of 10

Based on 2,576 frontline employees who took The Breakroom Quiz

77th of 116 rated security


Job description

Overview

Company Overview:

Advance Your Career in Insurance Claims with Allied Universal Compliance and Investigation Services. Allied Universal Compliance and Investigation Services is the premier destination for a career in insurance claim investigation. As a global leader, we provide dynamic opportunities for claim investigators, SIU investigators, and surveillance investigators. Our team is committed to innovation and excellence, making a significant impact in the insurance industry. If you're ready to grow with the best, explore a career with us and make a difference.

Job Description

Allied Universal is hiring a Special Investigations Unit (SIU) Investigator. Special Investigations Unit (SIU) Specialists investigate claims with red flags that suggest fraudulent behavior In relation to an Insurance claim. The SIU Specialist must use their extensive knowledge of Insurance policies and the components of fraud to determine If claims warrant reporting to the appropriate state agency for prosecution.

  • Pay Rate: $25 - $32 / hr 
  • Private Investigator's license required prior to applying 
  • Must possess a valid driver's license with at least one year of driving experience 

RESPONSIBILITIES:

  • Independently investigate suspected fraudulent insurance claims for a variety of coverage to include workers' compensation, general liability, property and casualty and disability
  • Acquire and gather information through use of own discretion, and guidance from clients and case managers, by means of data collection, interviews, research and collaboration with other SIU entities, law enforcement and state Departments of Insurance
  • Create and maintain detailed documentation for investigations, file reviews, audits, training tasks, consulting projects, and other assignments as directed
  • Produce professional and expert reports, memos, and letters that are clear, concise, and grammatically correct
  • Run appropriate database indices if necessary and verify the accuracy of results found
  • Independently develop a strategic plan to achieve assignment objectives, ensuring thorough documentation and effective communication with clients and their Special Investigation Unit Supervisor

QUALIFICATIONS (MUST HAVE):

  • Must possess one or more of the following:
    • Bachelor's degree in Criminal Justice
    • High School diploma or higher with a minimum of five (5) years of demonstrated professional law enforcement experience with specific attention to investigations related to fraud
  • Ability to be properly licensed as a Private Investigator as required by the state where work Is completed
  • Post offer, must be able to successfully complete the Allied Universal Investigations training/orientation course
  • Minimum of five (5) years of demonstrated experience conducting complex insurance investigations or adjusting complex insurance claims
  • Proficient understanding and application of anti-fraud laws, insurance regulations, and compliance standards within their home state and designated regional area.
  • Proficient in utilizing laptop computers and cell phones.
  • Special Investigative Unit (SIU) Compliance knowledge
  • Ability to type 40+ words per minute with minimum error
  • Flexibility to work varied and irregular hours and days including weekends and holidays

PREFERRED QUALIFICATIONS (NICE TO HAVE):

  • Military experience
  • Law enforcement
  • Insurance administration experience
  • Familiarity with California SIU regulations
  • One or more of the following professional industry certifications:
    • Certified Fraud Investigator (CFE)
    • Certified Insurance Fraud Investigator (CIFI)
    • Fraud Claim Law Associate (FCLA)
    • Fraud Claim Law Specialist (FCLS)
    • Certified Protection Professional (CPP)
    • Associate in Claims (AIC)
    • Chartered Property Casualty Underwriter (CPCU)

BENEFITS:

  • Medical, dental, vision, basic life, AD&D, retirement plan and disability insurance
  • Seven paid holidays annually, sick days available where required by law
  • Vacation time offered at an initial accrual rate of 3.08 hours biweekly; unused vacation is only paid out where required by law
Closing

Allied Universal is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race/ethnicity, age, color, religion, sex, sexual orientation, gender identity, national origin, genetic information, disability, protected veteran status or relationship/association with a protected veteran, or any other basis or characteristic protected by law. For more information: www.aus.com

If you have difficulty using the online system and require an alternate method to apply or require an accommodation, please contact our local Human Resources department. To find an office near you, please visit: www.aus.com/offices.

Requisition ID2026-1645668Employment Type: FULL_TIME

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About Allied Universal

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Allied Universal® is a leading security and facility services company. We provide proactive security services and cutting-edge smart technology to deliver evolving, tailored solutions that allow our clients to focus on their core business. Our excellence starts with our local leadership and local presence. Operating in more than 90 countries, our global workforce of approximately 800,000 people. Employees help to deliver our promise globally and locally: keeping people safe so our customers and communities can thrive. As we build the world's best services company, we continue to expand our footprint and infrastructure on a global and local level. In North America, we operate our business under the existing Allied Universal brand, and our international business operates under the G4S brand.

Industry

Investigation and physical security services, chemical manufacturing and real estate

Company size

10,000+ Employees

Headquarters location

Santa Ana, CA, US