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Medical Claims Rep Jobs (NOW HIRING)

gpac

Senior Claims Representative

Woburn, MA · On-site

$80K - $100K/yr

Senior Claims Representative, Workers Compensation Hybrid - Middlesex County | $80,000 - $100,000 ... Obtains details from witnesses, police, medical providers, and other sources; secures bills and ...

Tanner Clinic

Medical Claims Assistant

Kaysville, UT · On-site

Monday - Friday Essential Job Responsibilities: * Assist Senior Rep in resolving insurance claims ... Knowledge of basic medical terminology, after training Skills: * Using logic and reasoning to ...

Tanner Clinic

Medical Claims Assistant

Kaysville, UT · On-site

Monday - Friday Essential Job Responsibilities: * Assist Senior Rep in resolving insurance claims ... Knowledge of basic medical terminology, after training Skills: * Using logic and reasoning to ...

EMC

Claims Representative

$51K - $71K/yr

As a Claims Representative, you'll play a key role in helping clients navigate the claims process ... Secure and review medical records, bills, invoices, receipts, and other supporting documentation ...

Cabot Risk Strategies

Claims Representative

Woburn, MA · On-site

Claim Representative Responsible for all phases of assigned claims handling. Involved from taking ... Obtains information from witnesses, police, or doctors, etc., and secures medical bills or any ...

Cabot Risk Strategies Llc

Claims Representative

Woburn, MA · On-site

$60K - $70K/yr

CLAIM REPRESENTATIVE Purpose and Description Responsible for all phases of assigned claims handling ... Obtains information from witnesses, police, or doctors, etc., and secures medical bills or any ...

EMC Insurance Group, Inc.

Claims Representative

$51K - $71K/yr

As a Claims Representative, you'll play a key role in helping clients navigate the claims process ... Secure and review medical records, bills, invoices, receipts, and other supporting documentation ...

AmTrust Financial

Claims Representative

Dallas, TX · On-site

... Representative is responsible for prompt efficient review and disposition of insurance claims ... Obtain medical records and reports, police, ambulance and agency reports; photographs and ...

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How much do medical claims rep jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for medical claims rep in the United States is $20.88, according to ZipRecruiter salary data. Most workers in this role earn between $17.79 and $23.08 per hour, depending on experience, location, and employer.

What is a medical claims rep?

Medical Claims Representatives, also known as Medical Claims Processors or Examiners, are professionals who review, process, and adjudicate healthcare insurance claims submitted by patients or healthcare providers. They evaluate medical documentation, verify insurance coverage, determine payment eligibility, and ensure claims comply with policy guidelines. Their work is essential in ensuring that valid claims are paid out correctly and that any discrepancies or errors are investigated and resolved.

What are the key skills and qualifications needed to thrive as a medical claims rep?

To thrive as a Medical Claims Representative, you need a solid understanding of healthcare billing, insurance claims processes, and medical terminology, often supported by a high school diploma or associate degree. Familiarity with claims management software, electronic health record (EHR) systems, and coding systems like ICD-10 and CPT is typically required. Strong attention to detail, problem-solving skills, and effective communication help you manage complex claims and interact with patients and providers. These skills ensure accurate claim processing, minimize errors, and facilitate timely reimbursements in the healthcare system.

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

Medical Claims Representatives often face challenges such as handling high volumes of complex claims, navigating varying insurance policies, and ensuring timely communication with healthcare providers and patients. Staying organized, developing a strong understanding of medical terminology and insurance guidelines, and using claims management software can help manage these challenges. Regular training and support from experienced team members also play a crucial role in helping new representatives adapt and succeed in this fast-paced environment.

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

AspectMedical Claims RepMedical Billing Specialist
CredentialsHigh school diploma; certification often preferredHigh school diploma; certification often preferred
Work EnvironmentInsurance companies, healthcare providers, billing officesHealthcare facilities, billing companies, clinics
Job FocusReview and process insurance claims, ensure reimbursementPrepare and submit bills, manage patient accounts
Common TasksVerify insurance, resolve claim denialsGenerate invoices, follow up on payments

While both roles involve handling healthcare financial processes, Medical Claims Reps primarily focus on reviewing and processing insurance claims to secure reimbursement, whereas Medical Billing Specialists handle the creation and management of patient bills and payments. Both roles require similar certifications and work in healthcare or insurance settings, but their daily tasks and focus areas differ.

What states have the most Medical Claims Rep jobs?

States with the most job openings for Medical Claims Rep jobs include:

What are popular job titles related to Medical Claims Rep jobs?

For Medical Claims Rep jobs, the most frequently searched job titles are:

Medical Claims Rep jobs near you

Senior Claims Representative

Woburn, MA • On-site

gpac
Recruiting and Staffing Services • 51 - 200 employees
Learn more about gpacexternal

$80K - $100K/yr

Other

Re-posted yesterday

Job description

Senior Claims Representative, Workers Compensation

Hybrid - Middlesex County | $80,000 - $100,000

Join a growing, service-focused risk and claims organization known for its collaborative culture, client-centric approach, and commitment to professional development. This role offers the opportunity to step into a senior role on a high-performing team in a supportive, forward-thinking environment.

Overview

The Senior Claims Representative is responsible for all phases of assigned workers compensation claims handling, ensuring efficient, compliant, and high-quality outcomes.

Responsibilities
  • Gathers all required claim information from contacts and documents it for claim files and management review.
  • Conducts initial claim follow-up by phone or letter, ensuring all necessary information is received to process the claim.
  • Obtains details from witnesses, police, medical providers, and other sources; secures bills and proof of loss to support timely claim resolution.
  • Reviews coverage and authorizes claim payments within assigned authority limits.
  • Processes claim payments when appropriate and provides supporting documentation for management tracking.
  • Performs field investigations to ensure prompt and fair settlement of assigned claims.
  • Maintains responsibility for claims in accordance with established service standards.
Qualifications
  • 5+ years of experience in claims
  • Bachelor's degree preferred
  • Strong communication skills and attention to detail
  • Experience with Workers Comp/Bodily Injury preferred

For consideration, please email your resume to Bethany.Delahunt@gogpac.com

All qualified applicants will receive consideration without regard to race, age, color, sex (including pregnancy), religion, national origin, disability, sexual orientation, gender identity, marital status, military status, genetic information, or any other status protected by applicable laws or regulations. GPAC (Growing People and Companies) is an award-winning search firm specializing in placing quality professionals within multiple industries across the United States since 1990. We are extremely competitive, client-focused and realize that our value is in our ability to deliver the right solutions at the right time.

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About GPAC

Sourced by ZipRecruiter

GPAC (Growing People and Companies) is an award-winning search firm specializing in placing quality professionals within multiple industries across the United States since 1990. We are extremely competitive, client-focused and realize that our value is in our ability to deliver the right solutions at the right time.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Sioux Falls, SD, US

Year founded

1990

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