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Medical Claims Representative Jobs (NOW HIRING)

Addison Group

Claims Representative

Austin, TX · On-site

$21/hr

This position is eligible for Medical, Dental, Vision, & 401K Addison Group is partnering with a growing insurance administration organization to identify a detail-oriented Claims Representative to ...

Athene

Claims Representative

West Des Moines, IA · On-site

A Claims Representative at Athene is responsible for researching and processing claims requests ... Works with agents, agency personnel, claimants, beneficiaries, physicians, medical institutions ...

EquipmentShare

Claims Representative

Saint Louis, MO · On-site

Future Claims Representative Opportunities at EquipmentShare! EquipmentShare is accepting ... Full medical, dental, and vision coverage for full-time employees * Generous PTO + paid holidays ...

EquipmentShare

Claims Representative

Saint Louis, MO · On-site

Future Claims Representative Opportunities at EquipmentShare! EquipmentShare is accepting ... Full medical, dental, and vision coverage for full-time employees * Generous PTO + paid holidays ...

Brown & Brown

Senior Claims Representative

Carmel, IN · On-site

Senior Claims Representative Built on meritocracy, our unique company culture rewards self-starters ... Medical/Rx, Dental, Vision, Life Insurance, Disability Insurance * Financial Benefits: ESPP; 401k;

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 ...

gpac

Senior Claims Representative

Woburn, MA · On-site

$75K - $100K/yr

Senior Claims Representative, Workers Compensation Hybrid - Middlesex County | $75,000 - $100,000 ... Obtains details from witnesses, police, medical providers, and other sources; secures bills and ...

JNR Adjustment

Claims Representative

Minneapolis, MN · On-site

We are seeking a highly disciplined, process-driven Claims Representative to join our property ... Background or training in details-first compliance industries (such as Medical Billing, Coding, CNA ...

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All JobsFinance and Insurance JobsInsurance JobsInsurance Claims Specialist JobsMedical Claims Representative Jobs

Medical Claims Representative information

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How much do medical claims representative jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for medical claims representative 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 does a medical claims representative do?

A Medical Claims Representative is responsible for processing and reviewing insurance claims related to healthcare services. They evaluate medical documents, verify patient information, and ensure that claims are accurate and comply with insurance policies. Their job also includes communicating with healthcare providers, policyholders, and insurance adjusters to resolve discrepancies or gather additional information. Ultimately, they help ensure claims are paid correctly and in a timely manner.

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

To thrive as a Medical Claims Representative, you need strong knowledge of medical terminology, insurance policies, and claims processing, often backed by a high school diploma or associate degree in a related field. Familiarity with claims management software, ICD and CPT coding systems, and electronic health records is typically required. Attention to detail, problem-solving abilities, and effective communication skills are crucial soft skills for success. These skills and qualities are important because they ensure accurate claims processing, minimize errors, and provide excellent service to clients and healthcare providers.

What are some common challenges medical claims representatives face when handling complex claims?

Medical Claims Representatives often encounter challenges such as deciphering intricate medical documentation, ensuring compliance with ever-changing insurance regulations, and managing high volumes of claims with tight deadlines. They must carefully communicate with healthcare providers, policyholders, and other insurance professionals to resolve discrepancies or gather missing information. Staying organized, detail-oriented, and up-to-date on policy guidelines is key to overcoming these obstacles and ensuring accurate and timely claim processing.

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

AspectMedical Claims RepresentativeMedical Billing Specialist
CredentialsHigh school diploma; certification often preferredHigh school diploma; certification often preferred
Work EnvironmentInsurance companies, healthcare providers, third-party payersHealthcare facilities, billing companies, clinics
Job FocusProcessing and reviewing insurance claims for reimbursementPreparing and submitting billing statements to patients and insurers
Common UsageInsurance companies, healthcare providersMedical offices, billing services

While both roles involve handling healthcare financial transactions, Medical Claims Representatives primarily focus on processing insurance claims and ensuring proper reimbursement, whereas Medical Billing Specialists handle the creation and submission of billing statements to patients and insurers. Both roles require similar credentials and often work in healthcare or insurance settings, but their specific responsibilities differ.

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Medical Claims Representative jobs near you
Infographic showing various Medical Claims Representative job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.

Workers' Compensation Claims Representative

Claims Administrative Services, Inc.

Tyler, TX • Remote

Full-time

Medical

Re-posted 14 days ago

Job description

About Us

Claims Administrative Services, Inc (CAS) has served as a third-party administrator handling workers' compensation and property and casualty claims for a wide array of clients since 1990. In addition to our claims experience, CAS offers safety and loss control, cost containment services, and program administration. Every day our experienced professionals are on the job, reducing the frequency and severity of workplace injuries, managing associated claims costs, and helping injured employees return to work. Our personalized customer service combined with dedicated experience, innovation, and cost efficiency, assists our clients in reducing costs and protecting their employees.

Structure and Ownership

Heartland Security Insurance Group is the holding company for Claims Administrative Services, Inc. Heartland is comprised of seven different insurance and risk management businesses, providing products and services globally. Each of the companies offer solutions to distinct client groups in the federal, state and private sectors. The organization has been under continuous private family ownership for 50 years. Today, it has over 60 stockholders as well as ESOP ownership. In addition to providing an important retirement benefit to associates, the Employee Stock Ownership Plan (ESOP) assures that everyone in the organization has a vested interest in providing the very highest level of service to the client.

Commitment to the Community

Claims Administrative Services, Inc., and the parent organization, Heartland Security Insurance Group, have a long history of philanthropy to the local, national, and international communities.

Workers' Compensation Claims Representative

Primary Responsibility

The Claims Representative will manage an assigned caseload of medical only and lost time Workers’ Compensation claims from the first report of injury to resolution according to the applicable law. This includes making decisions about liability/compensability, evaluating losses, and negotiating settlements. The role interacts with claimants, policyholders, appraisers, attorneys, and other third parties throughout the claims management process. The position offers training developed with an emphasis on enhancing skills needed to help provide exceptional service to our customers. The Claims Representative will adjudicate medical only and lost time Workers' Compensation files according to applicable law.

Essential Functions & Responsibilities

Manage assigned caseload of workers’ compensation claims.

Make decisions about compensability, set reserves and negotiate settlements.

Interact with claimants, clients, medical providers and other third party representatives throughout the claims process.

Timely initial contacts and investigation of new claims.

Verify coverage.

Take recorded statements as needed.

Document files daily on every conversation and action taken.

Identify and address subrogation issues.

Start and stop indemnity benefits timely and accurately.

Complete jurisdictional forms timely and accurately.

Monitor ongoing medical treatment.

Request second medical opinions as needed.

Request surveillance appropriately.

Work mail and diary on a daily basis.

Client visits as required.

Preparation and handling of hearings

Additional Functions & Responsibilities

Communicates directly with client.

Prepares reports and other analytical data as requested by the management team.

Required Qualifications

Must hold a valid Workers’ Compensation Adjuster license.

Must have at least 2-3 years of experience handling indemnity workers’ compensation claims.

High school diploma.

Ability to follow instructions, procedures and rules.

Must have strong attention to detail.

Must have good written and oral communication skills.

Must be well organized and the ability to multi-task.

Basic computer skills in MS Word, Excel and Outlook.

Fast, accurate data entry

Preferred Qualifications

College degree in business or other related discipline.

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