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Medical Claims Processor Jobs in Philadelphia, PA

Delaware Claims

Claims Analyst

Wilmington, DE · On-site

Delaware Claims Processing Facility, a leader in mass tort litigation claims processing with over ... package includes medical, dental, vision, disability, parking stipend, 401-K, generous PTO ...

NJM Insurance Group

Bill Processor

Trenton, NJ · On-site

$42K - $49K/yr

Our MCS (Medical Claims Services) Medical Bill Processing Department has an opening for a Bill Processor and is seeking a candidate who has excellent communication skills as well as strong ...

Delaware Claims

Claims Analyst

Wilmington, DE · On-site

Delaware Claims Processing Facility, a leader in mass tort litigation claims processing with over ... package includes medical, dental, vision, disability, parking stipend, 401-K, generous PTO ...

NJM Insurance Group

Bill Processor

Trenton, NJ · On-site

$42K - $49K/yr

Our MCS (Medical Claims Services) Medical Bill Processing Department has an opening for a Bill Processor and is seeking a candidate who has excellent communication skills as well as strong ...

The Jonus Group

Agency Claims Advocate

Mount Laurel, NJ · On-site

$72K - $103K/yr

Claims Advocate Job Summary Seeking a dedicated and detail-oriented Claims Advocate to support clients through the claims process. In this role, you will be responsible for reporting, monitoring, and ...

MEDLOGIX, LLC

EDI Specialist

Lansdale, PA · On-site

Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and ...

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All JobsMedical Claims Processor JobsMedical Claims Processor Jobs in Philadelphia, PA

Medical Claims Processor information

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$14

$19

$25

How much do medical claims processor jobs pay per hour?

As of Aug 31, 2026, the average hourly pay for medical claims processor in Philadelphia, PA is $19.64, according to ZipRecruiter salary data. Most workers in this role earn between $17.45 and $21.83 per hour, depending on experience, location, and employer.

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 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.

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 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.

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 positions may offer on-the-job training or certification programs.
More about Medical Claims Processor jobs

What are the most commonly searched types of Medical Claims Processor jobs in Philadelphia, PA?

The most popular types of Medical Claims Processor jobs in Philadelphia, PA are:

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For Medical Claims Processor jobs in Philadelphia, PA, the most frequently searched job titles are:

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The top searched job categories for Medical Claims Processor jobs in Philadelphia, PA are:

What cities near Philadelphia, PA are hiring for Medical Claims Processor jobs?

Cities near Philadelphia, PA with the most Medical Claims Processor job openings:

Medical Claims Processor jobs near you
Infographic showing various Medical Claims Processor job openings in Philadelphia, PA as of August 2026, with employment types broken down into 65% Full Time, 17% Temporary, and 18% Contract. Highlights an 58% In-person, 21% Hybrid, and 21% Remote job distribution, with an average salary of $40,861 per year, or $19.6 per hour.

Claims Repricer

Philadelphia, PA • On-site

Independence Blue Cross
Insurance Services • 1 - 5K employees

8.8

Company rating: 8.8 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

58th of 315 rated insurance

Good employer

Recommended by parents

Respectful managers

Learn more about Independence Blue Crossexternal

Full-time

Re-posted 21 days ago

Job description

Position Summary
The Claims Repricer is responsible for the accurate review, adjustment, and application of pricing methodologies to medical claims. This role ensures claims are priced in accordance with provider contracts, fee schedules, and benefit structures. The position plays a critical role in maintaining pricing integrity, minimizing rework, and supporting operational efficiency in a high-volume claims environment.
Key Responsibilities
  • Review and reprice medical claims to ensure accurate application of provider contracts, fee schedules, and reimbursement methodologies
  • Analyze pricing discrepancies and perform adjustments to align with contractual and system guidelines
  • Research complex claims scenarios, including escalations from Provider Services and Claims Processing
  • Partner with Configuration, Network Management, and Claims teams to resolve pricing issues and system defects
  • Validate contract terms and ensure proper interpretation within claims adjudication systems
  • Maintain productivity, quality, and turnaround time standards in a high-volume environment
  • Document findings and maintain audit-ready records of adjustments and issue resolution
  • Identify pricing trends, root causes, and recommend process improvements to reduce errors and rework

Required Qualifications
  • High school diploma or equivalent required; Associate's or Bachelor's degree preferred
  • 2-4 years of experience in healthcare claims processing, pricing, or repricing
  • Strong knowledge of claims adjudication and reimbursement methodologies (e.g., fee schedules, contract pricing)
  • Experience interpreting provider contracts and pricing logic preferred
  • Strong analytical and problem-solving skills with attention to detail
  • Ability to manage fluctuating workloads and prioritize effectively
  • Proficiency in Microsoft Office (Excel, Word) and claims systems

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.

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