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Medical Claims Processor Jobs in Philadelphia, PA

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 ...

New

Corvel

Medical Only Claims Specialist

Norristown, PA · Hybrid

$16.74 - $26.92/hr

The Workers' Compensation Medical Only Claims Specialist manages non-complex and non-problematic ... process taking into consideration experience, qualifications, and overall fit for the role. The ...

Delaware Claims

Claims Analyst

Wilmington, DE · On-site

$52K/yr

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 ...

Delaware Claims

Claims Analyst

Wilmington, DE · On-site

$52K/yr

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 ...

New

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 ...

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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

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How much do medical claims processor jobs pay per hour?

As of Aug 23, 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.
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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:

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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.

Bill Processor

NJM Insurance Group

Trenton, NJ • On-site

$42K - $49K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted yesterday

New

Job description

NJM Medical Bill Processor

There's never been a better time to join NJM! With a nationally ranked reputation for outstanding customer service and a history that spans more than a century, NJM is a leading provider of worker's compensation, automobile, and homeowners insurance in New Jersey.

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 organizational and time management skills. Reporting to a Supervisor in Medical Claim Services Bill Processing, the Bill Processor (BP) is responsible and accountable for the timely audit and processing of medical bills. Timely and accurate processing is vital to ensuring that medical bills meet all regulatory timeframes.

Schedule: Monday-Friday, specific hours are subject to selected start times between 8:00am-9:00am pending supervisory approval.

Essential Duties and Responsibilities: Essential functions of this job are listed below in order of priority. Reasonable accommodations may be made to enable individuals to perform the essential duties. Regular and predictable onsite attendance is an essential function of the job.

  • Accurately audit and process standard medical bills for routine procedures within statutory timeframes, by following medical coding guidelines and department policies and procedures
  • Verify correct payee and provider information and ensure all bills that meet audit criteria are routed immediately for audit purposes.
  • Communicate with claims personnel relating to complex issues regarding authorizations, pre-certifications and compensability.
  • Apply state fee schedules when appropriate
  • Demonstrate working knowledge of the available computer systems (imaging, bill processing, claims) to insure prompt and accurate bill processing.
  • Research and respond by telephone/email to provider inquiries regarding billing issues in a timely manner

Required Qualifications: Knowledge, skills & abilities, experience, minimum & desired education, certification and/or license requirements.

  • High School Diploma or GED required
  • Associate Degree and/or coding certification, preferred
  • 1-2 years of insurance and/or medical office experience, preferred
  • Strong communication skills, including writing, speaking and active listening
  • Ability to learn quickly, work in fast paced environment and adapt to change
  • Organization, time management and prioritization abilities
  • Strong interpersonal and customer service skills
  • Ability to balance priorities by responding to customer concerns while performing thorough investigations of all issues encountered
  • Knowledge of CPT (Current Procedural Terminology) and ICD-10 codes a plus
  • Multi-state knowledge for Workers' Compensation and/or Personal Auto (PIP) a plus
  • Multi-tasking, problem-solving and decision-making abilities
  • Effective computer skills and ability to work in multiple systems
  • Ability to work independently

Compensation: Salary is commensurate with experience and credentials.

Pay Range: $42,577-$49,488

Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.

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