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Medical Claims Processor Jobs in Rochester, NY (NOW HIRING)

Deloitte

Epic Denials Management Operator

Rochester, NY · Remote

$17.75 - $23.75/hr

Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or ... 277 processing) received from third party payers. Conduct Denial categorization and root cause ...

w3r Consulting

Clinical Pharmacist

Rochester, NY · On-site

$116K - $139K/yr

... medical claims history to identify opportunities to improve therapeutic outcomes & reduce the risk ... Fundamental knowledge of drug information process/references and ability to conduct research

w3r Consulting

Clinical Pharmacist

Rochester, NY · On-site

$55/hr

... medical claims history to identify opportunities to improve therapeutic outcomes & reduce the risk ... Fundamental knowledge of drug information process/references and ability to conduct research

micro1 AI

Medical Billing Specialist

Rochester, NY · Remote

$50 - $80/hr

Medical Writer / Clinical Document Author Role Type: Contractor Location: Remote micro1 is engaging ... Trace narrative claims to source records--tables, figures, listings, and protocols--to verify that ...

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All JobsMedical Claims Processor JobsMedical Claims Processor Jobs in Rochester, NY

Medical Claims Processor information

See Rochester, NY salary details

$13

$19

$25

How much do medical claims processor jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for medical claims processor in Rochester, NY is $19.21, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $21.35 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 Rochester, NY are:

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The top searched job categories for Medical Claims Processor jobs in Rochester, NY are:

Medical Claims Processor jobs near you
Infographic showing various Medical Claims Processor job openings in Rochester, NY as of August 2026, with employment types broken down into 64% Full Time, 17% Temporary, and 19% Contract. Highlights an 59% In-person, 20% Hybrid, and 21% Remote job distribution, with an average salary of $39,953 per year, or $19.2 per hour.

Clm Resltion Rep III, Hosp/Prv

University of Rochester

Rochester, NY • Remote

$20.30 - $27.41/hr

Full-time

Re-posted 11 days ago

University Of Rochester rating

8.3

Company rating: 8.3 out of 10

Based on 186 frontline employees who took The Breakroom Quiz

126th of 618 rated colleges and universities

Job description

As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.

Job Location (Full Address):

Remote Work - New York, Albany, New York, United States of America, 12224

Opening:

Worker Subtype:

Regular

Time Type:

Full time

Scheduled Weekly Hours:

40

Department:

910402 United Business Office

Work Shift:

UR - Day (United States of America)

Range:

UR URCA 205 H

Compensation Range:

$20.30 - $27.41

The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.

Responsibilities:

The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.

ESSENTIAL FUNCTIONS

With general direction of the Manager/Supervisor/Lead:

  • Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services.
  • Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and takes appropriate action to assure claim resolution.
  • Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies.
  • Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution.
  • Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ's to identify opportunities for improvement in clean claims rate.
  • May perform other duties as assigned.


MINIMUM EDUCATION & EXPERIENCE

  • Associate's degree and 2 years of relevant experience required
  • Or equivalent combination of education and experience


KNOWLEDGE, SKILLS AND ABILITIES

  • Excellent problem-solving skills preferred
  • Excellent communication skills preferred
  • Excellent customer service skills preferred
  • Strong working knowledge of the professional billing software applications preferred
  • Ability to type 25 wpm preferred.

The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University's Mission to Learn, Discover, Heal, Create - and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status,or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.

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