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Medical Claims Processing Jobs in Virginia (NOW HIRING)

Wexford Health Sources

VA · On-site

Medical Director - Full or part time * Flexible - work around your current schedule (Mon-Friday ... claims processing, and quality management services. At Wexford Health our philosophy is that health ...

Chubb

ESIS Claims Representative, WC

Glen Allen, VA · On-site

$62K - $81K/yr

Act as the primary point of contact for injured workers, employers, medical providers, and other stakeholders, delivering clear and professional communication throughout the claims process.

Berkley

Claims Team Lead

Glen Allen, VA · On-site

... medical management, file management, litigation management, subrogation, reserving and settlement ... Coordinates and leads special projects or processes as assigned by senior management * Continuously ...

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All JobsMedical Claims Processing JobsMedical Claims Processing Jobs in Virginia

Medical Claims Processing information

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How much do medical claims processing jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for medical claims processing in Virginia is $19.30, according to ZipRecruiter salary data. Most workers in this role earn between $17.16 and $21.44 per hour, depending on experience, location, and employer.

What are some common challenges faced in medical claims processing, and how can professionals address them?

Medical claims processors often encounter challenges such as handling complex insurance policies, navigating frequent regulatory changes, and ensuring the accuracy of coding and billing information. To address these issues, professionals need to stay updated with industry regulations, maintain strong attention to detail, and communicate effectively with healthcare providers and insurance companies. Ongoing training and the use of specialized software can also help streamline workflows and minimize errors, making the process more efficient.

What is medical claims processing?

Medical claims processing is the administrative procedure of reviewing, validating, and handling healthcare claims submitted by providers to insurance companies or payers for reimbursement. This process involves checking the accuracy of the submitted information, verifying patient eligibility and coverage, and ensuring that services are medically necessary and properly coded. Claims processors work to approve, deny, or request additional information to resolve claims, ultimately ensuring that healthcare providers receive payment and patients are billed accurately.

Do you need a degree to be a medical claims processor?

A degree is not typically required to become a medical claims processor, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include knowledge of medical billing, coding, and claims processing software, and some certifications can enhance job prospects.

What is the difference between Medical Claims Processing vs Medical Billing?

AspectMedical Claims ProcessingMedical Billing
CredentialsTypically requires knowledge of insurance policies and claims proceduresRequires understanding of coding and billing practices
Work EnvironmentOften in insurance companies, healthcare providers, or claims processing centersPrimarily in healthcare provider offices or billing companies
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsHospitals, clinics, medical practices, billing services

Medical Claims Processing focuses on reviewing and submitting insurance claims for reimbursement, ensuring compliance with policies. Medical Billing involves coding patient services and generating bills for patients and insurers. While related, Claims Processing emphasizes claim review and approval, whereas Billing centers on creating accurate invoices for services rendered.

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

To thrive as a Medical Claims Processor, you need a solid understanding of medical terminology, insurance policies, and claims procedures, often supported by a high school diploma or associate degree. Familiarity with claims management software, healthcare coding systems (ICD-10, CPT), and electronic health record (EHR) systems is typically required. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and timely processing. These skills are crucial for minimizing errors, reducing claim denials, and supporting efficient healthcare reimbursement processes.

How to get a job as a medical claims processor?

To become a medical claims processor, candidates typically need a high school diploma or equivalent, with some roles preferring postsecondary training in healthcare administration or related fields. Relevant skills include attention to detail, knowledge of medical billing and coding, and proficiency with claims processing software. Certification such as the Certified Medical Reimbursement Specialist (CMRS) can improve job prospects, and previous experience in healthcare or insurance is often beneficial.

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

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

What are popular job titles related to Medical Claims Processing jobs in Virginia?

For Medical Claims Processing jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Medical Claims Processing jobs in Virginia look for?

The top searched job categories for Medical Claims Processing jobs in Virginia are:

What cities in Virginia are hiring for Medical Claims Processing jobs?

Cities in Virginia with the most Medical Claims Processing job openings:

Medical Claims Processing jobs near you
Infographic showing various Medical Claims Processing job openings in Virginia as of August 2026, with employment types broken down into 73% Full Time, 12% Part Time, and 15% Contract. Highlights an 93% In-person, and 7% Remote job distribution, with an average salary of $40,146 per year, or $19.3 per hour.

Claims Director, Professional Lines - Medical and Non-Medical

Jobtailor

Richmond, VA • On-site

$90 - $150/hr

Other

Posted 11 days ago

Job description

  • Directly handle high-exposure professional lines claims, including Allied Medical, Medical Professionals, Errors and Omissions, and Management Liability matters on both primary and excess policies
  • Review claims and related systems and processes
  • Understand and analyze policy language and contracts
  • Provide coverage, liability, and damages analysis for claims and ensure timely reserving and appropriate legal and indemnity payments
  • Develop and document claim strategy for complex professional liability matters, including regulatory, licensing, credentialing, standard-of-care, causation, damages, and consent-to-settle considerations where applicable
  • Draft disclaimer and reservation of rights letters
  • Negotiate settlements, mitigate losses, and control expenses
  • Adhere to Claims Best Practices, Key Controls, and file handling requirements
  • Maintain a high level of communication with leadership and underwriting partners
  • Identify trends, emerging exposures, procedural improvements, and underwriting feedback from claim activity
  • Present to management, support peer development, mentor new staff, and assist with organization-wide initiatives and improvement strategies for claims and business units
  • Ensure appropriate reports are timely prepared and disseminated
  • Ensure successful implementation of key organization-wide initiatives and improvement strategies for claims and our business units
  • Support other functional groups within the organization
  • Ensure compliance with internal corporate guidelines, processes and procedures
  • Other duties as required by management
  • Some travel, as required for trials & mediations, etc.
Requirements
  • 5+ years of experience, with progressive claims handling, litigation management, or related insurance industry experience
  • Experience handling claims in the Excess and Surplus market preferred
  • Experience handling professional lines claims, including Allied Medical, Medical Professionals, Errors and Omissions, and Management Liability is strongly preferred
  • Experience working with complex coverage issues required
  • Multi-jurisdictional claims and litigation experience required
  • Adjuster license and or certifications desired, but not required
  • Bachelor’s degree or equivalent experience, JD desirable
  • Highly advanced knowledge of claim processes, policies, procedures, claim systems, regulation, coverage, liability, damage evaluation, and/or settlement with exposures in excess of $1M
  • Strong negotiating, analytical, written, and organizational skills
  • Mediation and arbitration experience preferred
  • Strong computer skills (Microsoft Office Suite, SharePoint, and in-house claims systems)
  • Ability to prioritize and manage deadlines
  • Ability to work both independently and collaboratively as part of a team
  • Excellent at establishing close working relationships with other departments, including underwriting, operations, finance, IT, actuarial and legal
Core Competencies

Demonstrates extensive experience in handling high-exposure professional lines claims, including strong analytical and negotiation skills for complex coverage issues. Proficient in developing claim strategies and ensuring compliance with corporate guidelines and best practices.

Highest-signal resume keywords
  • Claims Handling Experience
  • Professional Lines Claims Expertise
  • Multi-Jurisdictional Litigation Experience
  • Strong Negotiating Skills
  • Advanced Knowledge of Claim Processes
ATS Optimization Keywords Hard Skills
  • Claims Analysis
  • Coverage Analysis
  • Liability Evaluation
  • Damage Evaluation
  • Settlement Negotiation
  • Claims Strategy Development
  • Regulatory Compliance
  • Mediation Experience
  • Arbitration Experience
  • Claims Systems Knowledge
Soft Skills
  • Analytical Skills
  • Organizational Skills
  • Communication Skills
  • Team Collaboration
  • Relationship Building
Certifications & Qualifications
  • Adjuster License
  • Insurance Certifications
Industry Keywords
  • Excess and Surplus Market
  • Allied Medical
  • Medical Professionals
  • Errors and Omissions
  • Management Liability
  • Claims Best Practices
  • Key Controls
  • Claims Handling Requirements
  • Licensing and Credentialing
  • Consent-to-Settle
Tools & Technologies
  • Microsoft Office Suite
  • SharePoint
  • In-House Claims Systems
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