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Medical Claims Negotiator Jobs (NOW HIRING)

Jonus Group

Workers Compensation Claims Director

Boston, MA · On-site

$120 - $140/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Comprehensive benefits package including medical, dental, vision, and 401(k) * Generous PTO and ... negotiations, and claim resolution . * Monitor claims performance, loss trends, reserve adequacy ...

New

WebTPA

Claims Examiner I

San Antonio, TX

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsible for processing of claims (medical, dental, vision, and mental health claims) * Claims processing and adjudication. * Claims research where applicable. * Reviews and processes insurance to ...

Guidewell

Claims Examiner I

San Antonio, TX

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Responsible for processing of claims (medical, dental, vision, and mental health claims) * Claims processing and adjudication. * Claims research where applicable. * Reviews and processes insurance to ...

USAA

Sr. Injury Claims Adjuster

Colorado Springs, CO · On-site +1

$63K - $117K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Proficient negotiation, investigation, communication, and conflict resolution skills ... Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

USAA

Sr. Injury Claims Adjuster

Colorado Springs, CO · On-site +1

$63K - $117K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Proficient negotiation, investigation, communication, and conflict resolution skills ... Proficient knowledge of human anatomy and medical terminology associated with bodily injury claims.

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Medical Claims Negotiator information

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How much do medical claims negotiator jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medical claims negotiator in the United States is $22.21, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $24.52 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a medical claims negotiator?

A Medical Claims Negotiator needs a solid understanding of medical billing, insurance claims processes, and healthcare regulations, typically supported by experience in healthcare administration or claims management. Proficiency in claims management software, medical coding systems (such as ICD-10 and CPT), and familiarity with payer portals are commonly required. Strong negotiation, analytical thinking, and communication skills help professionals effectively resolve disputes and secure favorable outcomes for clients or organizations. Mastery of these skills ensures timely, cost-effective settlements and fosters positive relationships between patients, providers, and insurers.

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

AspectMedical Claims NegotiatorMedical Billing Specialist
CredentialsCertification in claims or insurance processing often preferredCertification in medical billing or coding often preferred
Work EnvironmentInsurance companies, healthcare providers, or third-party payersHospitals, clinics, or medical offices
Primary FocusNegotiating claim settlements and maximizing reimbursementsPreparing and submitting medical bills and coding claims

The Medical Claims Negotiator primarily focuses on negotiating insurance claims and settlements, while the Medical Billing Specialist handles billing, coding, and submitting claims. Both roles require knowledge of insurance processes, but their core responsibilities differ, with negotiators emphasizing reimbursement negotiations and billing specialists managing claim submissions.

Is claims processing a stressful job?

Medical Claims Negotiators often find claims processing to be a demanding task due to strict deadlines, detailed documentation, and the need for accuracy. The job requires strong organizational skills and attention to detail, which can contribute to work-related stress, especially during high-volume periods or complex cases.

What are some common challenges faced by medical claims negotiators when working with insurance companies and healthcare providers?

Medical Claims Negotiators often encounter challenges such as complex policy language, varying reimbursement rates, and resistance from both payers and providers during negotiations. Balancing the interests of patients, insurance companies, and healthcare providers requires strong communication and problem-solving skills. Additionally, negotiators must stay updated on healthcare regulations and industry trends to effectively advocate for fair settlements. Building relationships and maintaining professionalism under pressure are key to overcoming these challenges and securing optimal outcomes.

What is a medical claims negotiator?

A Medical Claims Negotiator is a professional who acts as a liaison between patients, healthcare providers, and insurance companies to resolve billing disputes and reduce out-of-pocket medical expenses. They review medical bills, insurance policies, and claim denials to ensure charges are accurate and to negotiate lower costs on behalf of patients or organizations. Their goal is to facilitate fair settlements, clarify coverage, and help clients navigate the complex healthcare billing system.
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Medical Claims Negotiator jobs near you
Infographic showing various Medical Claims Negotiator 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 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $46,198 per year, or $22.2 per hour.

Claims Examiner/Senior Claims Examiner

Berkley

Walnut Creek, CA • On-site

$65K - $115K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 13 days ago

Job description

Company Details
Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company's distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.
Company URL: https://www.peiwc.com
The company is an equal opportunity employer.
Responsibilities
We are seeking Workers' Compensation Claims Examiners and Senior Claims Examiners to join our team. In these roles, you will be responsible for the analysis and management of moderate to complex workers' compensation claims, including reviewing, investigating, and making determinations around coverage, compensability, and claim appropriateness. You will ensure all claims are processed and documented in compliance with company standards, industry best practices, and applicable legislative requirements while acting in a fiduciary capacity on behalf of policyholders.
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with the rules, regulations, and statutes of the Workers' Compensation Appeals Board (WCAB) and the State of California. Success in this role requires strong judgment, consistent performance, and a high level of competency in negotiating settlements, managing subrogation, and delivering sound, compliant outcomes.
Key functions include but are not limited to:
  • Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
  • Negotiates settlement of claims up to designated authority level and makes claims payments.
  • Processes complex or technically difficult claims.
  • Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
  • Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
  • Prepares necessary state filings within statutory limits.
  • Actively manages the litigation process; ensures timely and cost-effective claims resolution.
  • Coordinates vendor referrals for additional investigation and/or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
  • Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
  • Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
  • Frequently communicates with all appropriate parties involved with the claim.
  • Refers cases as appropriate to management.
  • Maintains professional client relationships.
  • Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications
  • 2+ years claims management experience.
  • Professional certification as applicable to workers' compensation required
  • WCCP Preferred
  • In depth knowledge of appropriate insurance principles and laws for workers' compensation.
  • Strong written and verbal communication skills.
  • Strong organizational skills.
  • Strong negotiation skills
  • Strong analytical and interpretive skills.
  • PC literate.
  • Professional certification as applicable to workers' compensation required.

Additional Company Details
We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:
• Base Salary Range: $65,000 - $115,000 annually
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Sponsorship not Offered for this Role

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