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Medical Claims Processor Jobs in Chicago, IL (NOW HIRING)

Claritev

Medical Claims Investigator

Naperville, IL · On-site

$50/hr

This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of ...

AppleOne

Medical Billing

Chicago, IL

$60K/yr

The Medical Billing position supports accurate claims processing, payment posting, insurance follow-up, and revenue cycle operations. Candidates who are organized, reliable, and comfortable working ...

New

Allied

Stop Loss Claims Specialist II-Specific

Chicago, IL · On-site +1

$24 - $26/hr

Medical claims experience required. * Accounting or Finance background a plus. * Proficient with ... and process. It is at the Company's discretion to determine what pay is provided to a candidate ...

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All JobsMedical Claims Processor JobsMedical Claims Processor Jobs in Chicago, IL

Medical Claims Processor information

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How much do medical claims processor jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for medical claims processor in Chicago, IL is $20.05, according to ZipRecruiter salary data. Most workers in this role earn between $17.84 and $22.31 per hour, depending on experience, location, and employer.

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

Medical Claims Processors often encounter challenges such as handling complex insurance policies, keeping up with changing regulations, and resolving claim discrepancies. To manage these issues, strong attention to detail, continuous learning, and effective communication with providers and insurance representatives are essential. Many processors also rely on updated software and regular training to stay current with industry standards and maintain accuracy in claim adjudication.

What is a medical claims processor?

Medical claims processors work for a health care office or insurance company. Their job is to check medical insurance claims for proper billing codes, update the doctor or insurer about changes to the claim, and clarify concerns about patient benefits. It is essential that the billing codes match the medical services provided. As a medical claims processor, you also follow up with the insurer to discuss discrepancies and find out the status of claims. Current procedural terminology (CPT) and data entry are central parts of a medical claims processor’s job, as they often use Microsoft Office applications or a secure database to enter billing codes for services rendered.

What does a medical claims processor do?

A Medical Claims Processor is responsible for reviewing, evaluating, and processing health insurance claims submitted by policyholders or healthcare providers. Their main tasks include verifying patient and insurance information, examining medical codes, ensuring compliance with insurance policies, and determining the amount payable for each claim. They play a crucial role in making sure that claims are handled efficiently and accurately, helping both providers and patients navigate insurance benefits. Attention to detail, knowledge of medical terminology, and understanding insurance guidelines are essential skills for this role.

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

AspectMedical Claims ProcessorMedical Billing Specialist
CredentialsHigh school diploma; certification optionalHigh school diploma; certification often preferred
Work EnvironmentHealthcare offices, insurance companiesMedical offices, billing companies
Primary FocusReviewing and processing insurance claimsCreating and sending bills to patients and insurers
Common TasksVerifying claim accuracy, data entryCoding procedures, invoicing patients

While both roles involve handling healthcare financial data, Medical Claims Processors focus on reviewing and submitting insurance claims, whereas Medical Billing Specialists handle invoicing and billing patients. Both roles require attention to detail and knowledge of healthcare billing processes, but their daily tasks and focus areas differ.

Is a medical claims processor job in demand?

Medical claims processor jobs are in demand due to the ongoing need for healthcare administration and insurance processing. The role requires attention to detail and familiarity with claims processing software, and employment is expected to grow as healthcare coverage expands and insurance companies seek qualified staff.

What do you need to be a medical claims processor?

To become a medical claims processor, you typically need a high school diploma or equivalent, strong attention to detail, and familiarity with medical billing and coding software. Some employers prefer candidates with certification in medical billing or coding, such as the Certified Professional Coder (CPC). Good organizational skills and the ability to work with sensitive information are also important.

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, health insurance policies, and claims adjudication processes, often supported by a high school diploma or associate degree. Proficiency with claims management software, ICD and CPT coding systems, and electronic health record systems is typically required. Attention to detail, organizational skills, and the ability to communicate clearly with providers and patients are essential soft skills. These competencies ensure accurate claim processing, minimize errors, and help maintain efficient workflow within healthcare administration.
More about Medical Claims Processor jobs
What are the most commonly searched types of Medical Claims Processor jobs in Chicago, IL? The most popular types of Medical Claims Processor jobs in Chicago, IL are:
Medical Claims Processor jobs near you
Infographic showing various Medical Claims Processor job openings in Chicago, IL as of August 2026, with employment types broken down into 93% Full Time, and 7% Part Time. Highlights an 87% In-person, 3% Hybrid, and 10% Remote job distribution, with an average salary of $41,714 per year, or $20.1 per hour.

MEDICAL CLAIMS MANAGER

SEIU Healthcare IL Benefit Funds

Chicago, IL • On-site

$80K - $110K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 29 days ago

Job description

SEIU Healthcare IL Benefit Funds is a dynamic benefits administration organization committed to providing the highest quality health and retirement benefits in the most financially responsible manner, while always acting in the best interest of the union members. The Fund serves over 20,000 union workers in the Nursing Home, Home Care, Child Care and Personal Assistant industries with the delivery of health and pension benefits. Our 50+ employees epitomize the Fund's core values of quality service, interdependence, effectiveness, and accountability, and forge an alliance with one another to carry out our shared mission and common agreements for those we serve.
Position Summary:
The Claims Manager is responsible for overseeing the daily operations of the Claims Department. The Claims Manager leads the claims staff by effectively applying technical competencies and leadership strategies to oversee employee management and ensure the team meets all departmental policies, procedures and performance goals of the medical claims processing operations. The work will focus primarily on effective supervision of staff, end-to-end claim processing automation and optimization, and claims system configuration. The Claims Manager will coordinate initiatives and priorities with other leaders and departments, requiring a high proficiency of both collaboration and independent work to ensure plan participants and medical providers are being serviced with high-quality standards in a timely manner.
The Claims Manager will maintain a high standard of performance while identifying problems, developing solutions and process improvements, and resolving issues with direct reports and other stakeholders. This position reports directly to the Deputy Administrator, and provides collaborative support to all levels of leadership and staff.
The Claims Manager will be responsible for the following:
Key Duties and Responsibilities:
  • Oversee immediate direct reports in key functional areas including claims inventory and processing, production standards, system configuration, plan network development, vendor relations and interdepartmental processes and procedures.
  • Establish and monitor key performance indicators (KPIs) to track trends and progress of department goals and objectives; and the quality of work performed by employees in the pursuit of achieving goals and objectives and quality, productivity, and compliance standards.
  • Establish, assign, distribute, and monitor quality and quantity metrics to ensure all production standards are understood and met by employees and inventory levels are managed to meet processing timelines.
  • Ensure compliance and regulatory guidelines of multiemployer Taft-Hartley trust funds are adhered to, including but not limited to PPACA, CAA (No Surprises Act and Transparency Rules), DOL, ERISA, HIPAA, and other required guidelines.
  • Maintain knowledge of all Fund health plans and department operations.
  • Oversee the maintenance of plan documents, including but not limited to summary plan descriptions (SPD), summary of material modifications (SMM), and summary of benefits and coverage (SBC).
  • Triage and/or resolve escalated inquiries in a timely fashion from plan participants, unions, medical providers and/or billers.
  • Report on cost and performance outcomes of medical home plans, plan networks, disease management programs, and medical benefit initiatives while providing recommendations to enhance offerings to plan participants and manage medical costs.
  • Identify issues and problems, develop solutions, and prepare recommendations, including process improvements and enhancements of policies and procedures.
  • Assign, oversee and approve the development of departmental policies and procedures for consistency in claims processing operations.
  • Ensure the active operation and optimization of a benefits administration system(s) that fully supports the functions of the department.
  • Support the compilation and reporting of claims data to be analyzed and used for contracting, medical cost management, benefit improvement, disease management, vendor management, and member and provider relations initiatives.
  • Configure contract terms within the benefits administration system to ensure accurate payments are processed and reflected in the participant and provider explanation of benefits (EOBs, EOPs).
  • Communicate professionally to develop and maintain effective working relationships with internal leadership and staff, and external stakeholders and partners as directed, including but not limited to plan participants, medical providers, trustees, government agencies, unions, members, attorneys, and consultants.
  • Attend, facilitate, and/or participate in various meetings, including weekly leadership, department, one-on-one with staff, and technology related meetings, All Staff meetings, and assigned committee, training sessions, task force, and other meetings as deemed appropriate to share, discuss, and solution for issues, as well as identify potential process improvements.
  • Create agendas for all pre-scheduled meetings using the Purpose, Outcome, and Process (POP) Model and require distribution of thorough notes for each meeting.
  • Cultivate an environment of high morale, performance, empowerment, continuous improvement, innovation, team engagement and initiative.
  • Ensure proper and timely dissemination of all process, procedural and business updates to the team and interdepartmentally based on member and organizational requirements.
  • Maintain knowledge of State and Federal regulations, implementing best practices and changes regarding claims and billing requirements to achieve continuous improvement and productivity standards.
  • Perform other similar related duties, special projects, and multiple tasks as required.

Employee Relations
  • Meet weekly with staff to build relationships, review operational processes, provide performance progress, employee coaching, and feedback, at the department level and one-on-one.
  • Accurate and timely review and approval of time off requests and bi-weekly payroll processing for direct reports.
  • Direct supervision of Medical Claims staff; consult with the Deputy Administrator and Human Resources in the employment lifecycle of direct reports.
  • Prepare and conduct timely annual employee performance evaluations.
  • Respond consistently, timely, and accurately to employee questions, issues, concerns, performance reviews, and feedback, referencing guidelines outlined in the employee manual, CBA, and/or other policies and procedures.
  • Enforce adherence of and compliance with written personnel policies, procedures, and communications approved by executive leadership.
  • Deliver regular and timely coaching and feedback with departmental staff on navigating departmental challenges, employee engagement, skills training and career development, employee discipline, and performance improvement.
  • Provide mentorship and guidance to department staff to ensure retention of high performing and motivated employees who meet performance benchmarks, align with the organizational mission and processes to achieve shared goals, and have training and development opportunities.
  • Work closely in a collaborative team approach with Deputy Administrator and Human Resources on personnel and career development matters, timelines, goals, workforce readiness and stabilization, and succession planning.

Privacy and Security Responsibilities:
This position requires the handling of Personal Identifiable Information (PII) and potentially Protected Health Information (PHI) for our members. You will be responsible and accountable for maintaining the confidentiality, integrity, and availability of all PII and PHI. Report any suspected identity or HIPAA violation or breach to our HIPAA Privacy and Security Officer.
Requirements
Desired Qualifications, Experience, and Characteristics:
  • 7+ years of experience working in a Taft-Hartley environment, benefit administration, third party administrator (TPA), managed care, self-insured plans, non-profit, labor unions, movement building, and/or mission-driven organizations.
  • 4+ years of managerial experience, preferably in medical insurance, medical claims or healthcare billing operations, benefits administration, or third-party administration.
  • Bachelor's degree required, in business management, healthcare administration, or other relevant fields.
  • An equivalent combination of education, certification, training and/or work experience may be used to meet the minimum education qualifications.
  • Demonstrated leadership knowledge, skills, experience, and the implementation of best practices, with a familiarity of healthcare, social-economic and labor movements, and political issues that impact the organization.
  • Demonstrated professional accountability and practiced use of self, with the commitment to manage up, laterally, and to direct reports in a collaborative manner.
  • Excellent written, verbal, and non-verbal communication and interpersonal skills to clearly articulate and share meaning of complex issues to a wide variety of audiences including peers, staff, leaders, and internal and external stakeholders and partners.
  • Demonstrated knowledge and experience working with contracts.
  • Experience in methods analysis and work simplification to enhance operational efficiencies.
  • Ability to collect, research, and synthesize complex information to provide data-informed recommendations in detailed reports for leadership, with a keen sense of insight and experience to complement the data.
  • Excellent organizational and time-management skills, with demonstrated experience developing and implementing individual and group timelines in a changing and emergent environment to successfully meet established goals, objectives, and timelines.
  • An accomplished and agile change management leader with proven experience demonstrating resiliency to setbacks and applying strong analytical skills and discernment toward problem/issue identification and resolution.
  • Demonstrated record of accomplishment leading and working with organizations that center and value diversity, equity, inclusion and belonging while advocating for human and technical systems that support racial, gender and socio-economic equality and justice in the workplace.

Personal Characteristics
  • A passionate commitment to the Mission, Vision, and Core Values of the SEIU Healthcare IL Benefit Funds.
  • A sense of grace and humor in the face of challenges.
  • Demonstrated creative innovation to advance and align organization culture, structure, and skills.
  • An exceptional team spirit and positive attitude, along with a high degree of integrity and judgment to earn and maintain employee and team confidence, morale and engagement.

Technical Experience
  • Strong knowledge of industry standard medical coding, including ICD-10 diagnosis codes, CPT procedure codes, HCPC codes, HCFA 1500 and UB-02 claims forms; and in-depth claims processing, billing analysis, subrogation, medical and pharmacy benefits expertise.
  • Advanced user of benefits administration software, Basys/Bridgeway preferred.
  • Intermediate user of project management tools, Smartsheet preferred.
  • Experienced leadership in a hybrid work model, providing in-person support and reliable remote work output and relationship building.
  • Technical facilitation and meeting moderation in a variety of virtual conference platform settings and in-person.
  • Intermediate to advanced skill level, using Microsoft Office Suite (Word, Excel, Outlook, and Power Point).
  • Knowledgeable use of printers, copiers, scanners, fax machines, and other office equipment.

Career Development & Continuing Education Opportunities: Yes
Benefits:
SEIU Healthcare IL Benefit Funds offers a comprehensive health benefit (medical, dental and vision coverage) for employees and eligible dependents, including no employee premium option for employee only; competitive compensation; generous holidays and PTO policies; and a pension retirement plan.
Salary Description
80,000-110,000

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