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Medical Claims Representative Jobs (NOW HIRING)

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 Co

Claims Representative

Minneapolis, MN · On-site

$19 - $21/hr

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 ...

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 ...

New

CarepathRx

Claims Representative - Remote

$19/hr

Claims Representative - Remote The claims representative is responsible for manually reviewing and ... Validate the accuracy of medical codes provided in claim submissions. * Assess the eligibility ...

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How much do medical claims representative jobs pay per hour?

As of Aug 13, 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?

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 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.
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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 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.

Senior Claims Representative

gpac

Woburn, MA • On-site

$75K - $100K/yr

Other

Re-posted just now

Job description

Job Description
Senior Claims Representative, Workers Compensation
Hybrid - Middlesex County | $75,000 - $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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