ZipRecruiter

Log In

1

Medical Claims Representative Jobs (NOW HIRING)

CBCS

Claims Representative

Des Moines, IA · On-site

As a Claims Representative you will: * Analyze and process claims * Talk with injured employees ... Salary * Most Benefits start Day 1 * Medical, Dental, Vision Insurance * Flex Spending or HSA ...

Installs LLC

Claims Representative

Buffalo, NY

$17 - $21/hr

Join CRST as a Claims Representative and help us deliver on our promises while driving success that ... Comprehensive package including medical, dental, and vision coverage; prescription drug and ...

New

Powers Health

Claims Rep - Clinic

East Chicago, IN · On-site

$18 - $26.37/hr

Position : Claims Rep - Clinic Location : ST. Catherine's Hospital, East Chicago, IN 46312 Job ... Knowledge of medical terminology and CPT/ICD-9 coding necessary. * Comprehension of government and ...

Powers Health

Claims Rep - Clinic

East Chicago, IN · On-site

Position : Claims Rep - Clinic Location : ST. Catherine's Hospital, East Chicago, IN 46312 Job ... Knowledge of medical terminology and CPT/ICD-9 coding necessary. * Comprehension of government and ...

next page

Showing results 1-20

People also search for

All JobsMedical Claims Representative Jobs

Medical Claims Representative information

See salary details

$13

$20

$29

How much do medical claims representative jobs pay per hour?

As of Jun 11, 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 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.

What are the key skills and qualifications needed to thrive as a Medical Claims Representative, and why are they important?

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.

Is being a claim adjuster worth it?

A Medical Claims Representative evaluates insurance claims related to healthcare services, ensuring accurate processing and compliance. The role typically requires attention to detail, knowledge of medical billing, and familiarity with claims processing software; it can offer stable employment with opportunities for advancement. Whether it is worth it depends on individual career goals and interest in the healthcare and insurance industries.

Is there a demand for claims adjusters?

There is steady demand for claims adjusters, including those working in medical claims, due to the ongoing need for insurance claims processing across various industries. Employment in this field is expected to grow as insurance companies require skilled professionals to evaluate and settle claims efficiently, often requiring knowledge of insurance policies and claims management software.

Is it hard to become a claims adjuster?

Becoming a claims adjuster typically requires completing a training program or obtaining a license, which involves passing an exam and meeting state-specific requirements. The job demands strong communication skills, attention to detail, and knowledge of insurance policies, but the difficulty varies based on individual background and preparation.

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 kind of claims adjuster makes the most money?

In the claims adjusting field, catastrophic claims adjusters, who handle large-scale and complex claims such as natural disasters or major accidents, tend to earn the highest salaries. These adjusters often require specialized knowledge, certifications, and experience, and they may work long hours in challenging environments to resolve high-value claims efficiently.
More about Medical Claims Representative jobs
What cities are hiring for Medical Claims Representative jobs? Cities with the most Medical Claims Representative job openings:
What are the most commonly searched types of Medical Claims Representative jobs? The most popular types of Medical Claims Representative jobs are:
What states have the most Medical Claims Representative jobs? States with the most job openings for Medical Claims Representative jobs include:
What job categories do people searching Medical Claims Representative jobs look for? The top searched job categories for Medical Claims Representative jobs are:
What are popular job titles related to Medical Claims Representative jobs? For Medical Claims Representative jobs, the most frequently searched job titles are:
Medical Claims Representative jobs near you
Infographic showing various Medical Claims Representative job openings in the United States as of June 2026, with employment types broken down into 84% Full Time, 15% Part Time, and 1% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.
Claims Representative - Workers Comp | Las Vegas, NV - 100% in Office

Claims Representative - Workers Comp | Las Vegas, NV - 100% in Office

Sedgwick

Las Vegas, NV • On-site

Full-time

Medical, Dental, Vision, Retirement

Posted 20 days ago

Sedgwick rating

7.5

Company rating: 7.5 out of 10

Based on 308 frontline employees who took The Breakroom Quiz

186th of 260 rated insurance

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Representative - Workers Comp | Las Vegas, NV - 100% in Office
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?
  • Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
  • Leverage Sedgwick's broad, global network of experts to both learn from and to share your insights.
  • Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
  • Enjoy flexibility and autonomy in your daily work, your location, and your career path.
  • Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

ARE YOU AN IDEAL CANDIDATE? We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
PRIMARY PURPOSE OF THE ROLE: To process low level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements with general supervision.
LOCATION:
In office 5 days, 37.5 hours per week.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE:
  • Processes low level workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
  • Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments.
  • Approves and processes assigned claims, determines benefits due, and administers action plan pursuant to the claim or client contract.
  • Administers subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.

ADDITIONAL FUNCTIONS and RESPONSIBILITIES
  • Performs other duties as assigned.
  • Supports the organization's quality program(s).
  • Travels as required.

QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Experience
Two (2) years of claims management experience or equivalent combination of education and experience or successful completion of Claims Representative training required.
Jurisdiction Knowledge: Nevada
Licensing: Nevada Staff Adjuster License preferred; will be required to obtain post hire Sedgwick funded*
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day on
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

What Sedgwick employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply