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Medical Claims Representative Jobs (NOW HIRING)

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 ...

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 ...

RemX

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Medical Claims Eligibility Specialist - Billing & Collections

Houston, TX · On-site

$22/hr

Medical Biller, Medical Collections Specialist, Claims Specialist, Insurance Follow-Up Representative, or Healthcare Reimbursement Specialist. Important: Candidates should live within approximately ...

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 ...

Reliant Medical Group

Claims Representative

$18 - $32/hr

Claims Representative/Insight Analyst Assistant This position is national remote. You'll enjoy the ... Process medical record submissions through various avenues. * Manages cases from the time of ...

Chubb

ESIS Claims Representative, WC

Tampa, FL · On-site

Workers' Compensation Claims Representative Are you looking to grow your career in workers ... Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees ...

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 ...

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 ...

Cigna

Claims Representative - Remote

$19/hr

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

Chubb

ESIS Claims Representative, WC

Alpharetta, GA · On-site

Workers' Compensation Claims Representative Are you looking to grow your career in workers ... Monitor and manage claim costs, including medical expenses, indemnity payments, and legal fees ...

Reliant Medical Group

Claims Representative

$18 - $32/hr

Claims Representative/Insight Analyst Assistant This position is national remote. You'll enjoy the ... Process medical record submissions through various avenues. * Manages cases from the time of ...

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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.

Claims Representative

Cabot Risk Strategies

Woburn, MA • On-site

Other

This job post has expired today. Applications are no longer accepted.

Job description

Claim Representative

Responsible for all phases of assigned claims handling. Involved from taking initial contact to forwarding claims payment to insured. Carefully documents all claims information and maintains accurate records complying with established claim procedure requirements.

Essential Job Functions
  1. Secures all required claims information from contact and transcribes it for claims file and management review.
  2. Follow-up contact by telephone or by letter with claimant on initial reporting of claim. Assures that all information required to take action on claim has been submitted.
  3. Obtains information from witnesses, police, or doctors, etc., and secures medical bills or any other proof of loss required to settle claims as quickly and effectively as possible.
  4. Determines coverage and requests payment on claims handled under specified authority.
  5. Issues claims payments on claims when appropriate. Will provide required documentation to management for tracking all claims.
  6. Conducts field investigations required for prompt and equitable settlement of all assigned claims.
  7. Responsible for all claims meeting established service standards.
  8. Other duties and projects as may be assigned from time to time.
Minimum Requirements

The following are required to enable the employee to perform the essential functions of the job.

  1. Skills/knowledge – Excellent communications skills (verbal and written) required, along with the ability to handle in a professional manner claimants who may be upset or impatient. Must be able to maintain credibility with clients and develop a strong, ongoing business relationship with assigned clients. Ability to follow a task through to a timely completion is mandatory. The ability to operate a personal computer, calculator, typewriter, fax, copy machine, shredder, and telephone is essential.
  2. Experience/education – Minimum of one to three years in handling property and casualty claims required. Must have completed at least one AIC or AEI source or have considerable work experience. College degree required or equivalent work experience considered.

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