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Medical Claims Negotiator Jobs (NOW HIRING)

Guidewell

Claims Examiner I

Irving, TX · On-site

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

Irving, TX · On-site

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

Irving, TX · On-site

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 ...

WebTPA

Claims Examiner I

Irving, TX · On-site

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 ...

WebTPA

Claims Examiner I

Irving, TX

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

Irving, TX · On-site

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 ...

Techlink Systems

Be Seen First

Claims Adjuster - Workers Compensation (Hourly)

OR · Remote

$27 - $32/hr

May process complex lifetime medical and/or defined period medical claims which include state and ... Excellent negotiation skills * Ability to work in a team environment * Ability to meet or exceed ...

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Medical Claims Negotiator information

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How much do medical claims negotiator jobs pay per hour?

As of Sep 4, 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 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.

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 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 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 stress levels, especially during high workload periods or complex cases.

What cities are hiring for Medical Claims Negotiator jobs?

Cities with the most Medical Claims Negotiator job openings:

What states have the most Medical Claims Negotiator jobs?

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

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, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $46,198 per year, or $22.2 per hour.

Medical Claims Recovery Specialist (Subrogation) - Tucker, GA - Hybrid

Gainwell Technologies LLC

Tucker, GA • Hybrid

$43K - $48K/yr

Full-time

Medical, Life, Retirement, PTO

Re-posted 2 days ago

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 83 frontline employees who took The Breakroom Quiz

138th of 247 rated software companies

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

We are seeking a Medical Claims Recovery Specialist to manage all casualty and estate functions involving state Medicaid beneficiaries or deceased Medicaid beneficiaries. This role is responsible for the intake, maintenance, claims review, case management, settlement, and all related activities within the assigned caseload.

Your role in our mission
  • Ensure all processes meet HIPAA and government security requirements regarding the sharing and storage of Personal Health Information (PHI).
  • Utilize strong analytical and case management skills to oversee 700–1,000 subrogation cases simultaneously.
  • Communicate professionally—primarily via inbound and outbound calls—with attorneys, insurance adjusters, medical providers, court staff, recipients, family members, and clients.
  • Prepare and manage required correspondence, liens, claims, and related documentation throughout the recovery process.
  • Meet departmental goals for customer service, settlements, and case handling standards.
  • Perform both basic and advanced document and legal reviews to determine case status, ensure accuracy, and support workflow progression.
  • Verify beneficiary eligibility and maintain accurate documentation.
  • Confirm and validate third-party liability, probate, and asset research findings.
  • Compile and analyze information from multiple sources to determine case status and recovery potential.
  • Process and resolve claim or lien disputes; collaborate with attorneys and relevant stakeholders as needed.
  • Conduct periodic follow-ups on case status, payments, and settlement updates.
  • Negotiate and finalize claim or lien settlement amounts according to established contract guidelines.
  • Execute and file notarized documents with applicable county offices.
  • Prioritize case events, payment issues, and revenue-impacting deadlines to ensure timely resolution.
  • Maintain accuracy, timeliness, and productivity standards for file management and phone metrics
What we're looking for
  • 2+ years of relevant professional experience in subrogation, claims, or case management.
  • Proficiency in Microsoft Word and Excel; basic knowledge of Microsoft Access is preferred.
  • Experience in a legal or insurance office setting (paralegal, legal assistant, casualty, or health insurance experience preferred).
  • Familiarity with Medicaid and/or Medicare programs is preferred
What you should expect in this role

•    Hybrid work arrangement based in the Tucker, GA office — onsite 2 days per week.
•    Schedule: Monday–Friday, 8:00 AM – 5:00 PM.
•    Video cameras are required during all interviews and throughout the first week of orientation.
•    To work effectively as a teleworker or hybrid employee, you must have broadband internet with a minimum speed of 24 Mbps download and 8 Mbps upload (higher speeds recommended for optimal performance).

This posting is intended for pipelining. We will accept applications on an ongoing basis.


#LI-HYBRID #LI-JA1 #LI-CM1

The pay range for this position is $43,500.00 - $48,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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