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Medical Claims Jobs (NOW HIRING)

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that ...

Claritev

Medical Claims Investigator

Naperville, IL · On-site

$50K/yr

Medical Claims Investigator At Claritev, we pride ourselves on being a dynamic team of innovative professionals. Our purpose is simple - we strive to bend the cost curve in healthcare for all. Our ...

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that ...

Datamark, Inc.

Medical Claims Processor

El Paso, TX

$16.50/hr

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your attention to detail and problem-solving skills make a real impact? Do you thrive in an environment that ...

Adecco

Medical Claims Examiner

San Antonio, TX · On-site

$21/hr

Key Requirements Recent medical claims experience REQUIRED Experience with medical claims adjudication Knowledge of Medicaid and Medicare guidelines Strong understanding of healthcare terminology and ...

Adecco

Medical Claims Examiner

San Antonio, TX · On-site

$21/hr

Key Requirements Recent medical claims experience REQUIRED Experience with medical claims adjudication Knowledge of Medicaid and Medicare guidelines Strong understanding of healthcare terminology and ...

Adecco

Medical Claims Examiner

San Antonio, TX

$21/hr

Key Requirements Recent medical claims experience REQUIRED Experience with medical claims adjudication Knowledge of Medicaid and Medicare guidelines Strong understanding of healthcare terminology and ...

Wilson-McShane Corp

MEDICAL CLAIMS ADJUSTER

Duluth, MN · On-site

$24/hr

As a Medical Claims Adjuster with Wilson-McShane Corporation, you will be processing medical, and short-term disability claims. This position has direct impact on the participants and families of the ...

Centerprise

Medical Claims Specialist

Loveland, OH · On-site

$18 - $22/hr

The Medical Claims Specialist performs a variety of billing and administrative tasks including claim submission, claim correction, insurance follow-up and appeals and insurance verification. They ...

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Medical Claims information

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$5

$16

$18

How much do medical claims jobs pay per hour?

As of Jun 10, 2026, the average hourly pay for medical claims in the United States is $16.83, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $18.27 per hour, depending on experience, location, and employer.

What are medical claims?

Medical claims are formal requests submitted by healthcare providers or patients to insurance companies, asking for payment for medical services rendered. These claims contain detailed information about the patient, the services provided, dates of service, and relevant medical codes. Insurance companies review the claims to determine coverage and reimburse providers or patients accordingly. Accurate and timely submission of medical claims is crucial to ensure proper payment and avoid delays or denials.

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

To thrive as a Medical Claims Specialist, you need knowledge of medical terminology, insurance policies, and claims processing, typically supported by a high school diploma or relevant certification. Familiarity with claims management software, electronic health records (EHRs), and billing systems such as ICD-10 and CPT coding is essential. Attention to detail, strong organizational skills, and effective communication help ensure accuracy and resolve claim discrepancies. These skills are crucial for ensuring timely and accurate claims processing, minimizing errors, and maintaining compliance with healthcare regulations.

What are some common challenges faced in a medical claims role, and how can they be effectively managed?

Medical claims professionals often encounter challenges such as handling denied or complex claims, navigating frequent regulatory changes, and communicating with both patients and insurance providers. Staying updated with the latest healthcare regulations and payer requirements is essential to minimize claim rejections. Effective time management, attention to detail, and strong communication skills help resolve issues quickly and ensure accurate processing. Collaborating closely with billing teams and healthcare providers also aids in addressing discrepancies and expediting claim approvals.

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

AspectMedical ClaimsMedical Billing Specialist
CredentialsTypically requires knowledge of insurance policies and coding; certifications like CPC or CCS are commonRequires similar certifications; focuses on billing processes and insurance claims
Work EnvironmentHealthcare facilities, insurance companies, billing companiesMedical offices, hospitals, billing companies
Job FocusSubmitting and managing insurance claims for reimbursementPreparing and sending bills to patients and insurers, managing accounts

Medical Claims specialists primarily handle the submission and management of insurance claims to ensure healthcare providers receive payment. Medical Billing Specialists focus on creating and sending bills to patients and insurance companies, managing payments, and maintaining billing records. While both roles require knowledge of insurance processes and coding, Medical Claims roles are more centered on claims submission and follow-up, whereas Medical Billing Specialists handle the overall billing process and patient invoicing.

More about Medical Claims jobs
What cities are hiring for Medical Claims jobs? Cities with the most Medical Claims job openings:
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Medical Claims jobs near you
Medical Claims Specialist

Medical Claims Specialist

Southeast Alaska Regional Health Consortium

Juneau, AK • On-site

$25 - $28.45/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 17 days ago

Southeast Alaska Regional Health Consortium rating

8.2

Company rating: 8.2 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

Job description

Pay Range:$25.00 - $28.45Under the direction of the Director of Purchased/Referred Care (PRC), the Medical Claims Specialist is primarily responsible for timely and accurately processing/payment of medical claims into the PRC claims processing package while providing excellent customer service to claimants and vendors. Maintains good vendor relations, works closely and follows up with accounts payable while maintaining compliance with all Federal, State, Tribal Health, and SEARHC PRC guidelines and regulations.
Must work independently making judgment calls when supervisor is not available. Position requires the ability to sit for long periods of time in front of a computer terminal. Mental fatigue exists with the high level of concentration necessary to properly process medical claims for payment accurately and timely. The employee must be able to work under stressful conditions. The PRC office maintains copies of each individual patient record as required by law and SEARHC policy and this position ensures that requirement is met. May occasionally encounter verbal abuse from customers or family members.
SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.
Key Essential Functions and Accountabilities of the Job
  • Clerical duties such as answering p hone, greeting patients and visitors, sending/receiving faxes, responsible for incoming and outgoing mail and responsible for security of all these forms of communication for patient confidentiality. Responsible for maintaining files including purging and shredding documents as needed and initiating and processing of denial and other letters as delegated by lead medical claims specialist. Review and screen all medical and dental claims from PRC health care providers. This requires verifying that the patient on claim is in our system using Cerner.
  • Performs alternate health resource verification.
    Responsible for providing new or updated demographic information and any alternate health resource information to Patient Access.
    Review claims to determine if a referral is on file.
    Coordinate with Patient Access department to generate a new health record for patients who are in outlying areas and have not previously registered at SEARHC.
    Establish patient eligibility according to established policies and procedures.
    Review ICD, CPT, and revenue codes to determine if diagnosis and treatment are authorized as part of the initial referral.
  • Management of data into the PRC claims processing program so that vendors can be paid timely. Process claims, using Medicare-like Rates when appropriate, for patients authorized to receive health services from facilities and providers outside of SEARHC.
  • Coordinate quarterly with CMS to obtain current Medicare-like Rates for non-tribal facilities.
    Perform insurance verification on each eligible beneficiary, review procedure and diagnosis codes to determine if services are covered under the SEARHC and Federal guidelines for reimbursement.
    Research unauthorized claims and take appropriate action.
    Provide alternate health resource information to private providers and facilities for all referred patients.
  • Provides assistance to customers regarding referrals and/or claim status, payment, patients admitted to non-tribal facilities, outstanding charges, and eligibility. Initiates, enters/update patient eligibility according to established procedures and Federal guidelines. Interpret PRC Program regulations, policies, and procedures to internal and external customers. Perform other duties as assigned.

Additional Details:
Education, Certifications, and Licenses Required
  • High school diploma or equivalent.
  • Medical terminology course required or 1 year of documented experience in a medical field requiring consistent use of medical terminology.

Experience Required
  • 1 year of data entry experience with basic knowledge of accounts payable processing, MS Excel, and MS Word software applications.
  • 3 years of business or medical office experience OR an equivalent combination of education and experience.
  • Medical coding background preferred.

Knowledge of
  • State, federal, and tribal health care programs.
  • Medical insurance process.
  • ICD and CPT coding.

Skills in
  • Interpreting state, federal, and tribal contract health care guidelines.
  • Research and problem solving.
  • Oral/written interpersonal communication and excellent customer service skills.

Ability to
  • Ability to multitask.
  • Ability to enter large volumes of data timely and accurately.
  • Ability to work independently with minimal supervision.
  • Ability to respond quickly in urgent situations with attention to detail.

Position Information:
Work Shift:OT 8/40
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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