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Medical Claims Jobs (NOW HIRING)

Claritev

Medical Claims Investigator

Naperville, IL · On-site

$50/hr

This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of ...

AJC Search Associates, Ltd.

Employee benefits Consulting Firm's growth creates the need for an experienced individual with an excellent Medical claims background and strong negotiating skills to join their team. Salary: $map ...

RemX

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Remote Medical Claims Specialist- $26/Hr.

Cleveland, OH · Remote

$26/hr

Remote Medical Claims Specialist- $26/Hr. Temp to Hire 100% Remote | Full-Time | M-F | 8AM-5PM CST We're seeking experienced Medical Claims Billing Coordinators to join a fast‐paced ...

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CNSCares

Medical Claims Specialist

Overland Park, KS · On-site

$20 - $24/hr

... medical records as necessary. * Help claimants file initial claims and refile claims that have been denied. * Inform individuals of the resources available that may assist their claim process and ...

RemX

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Fully Remote Medical Claims Rep- $26/Hr.

Charlotte, NC · Remote

$26/hr

Remote Medical Claims Billing Coordinator (Contract-to-Hire) 100% Remote | Full-Time | M-F | 8AM-5PM CST We're seeking experienced Medical Claims Billing Coordinators to join a fast‐paced ...

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MET Healthcare Solutions

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Medical Claims Eligibility Specialist II-Hybrid

Houston, TX · On-site

$23 - $25/hr

The Medical Claims Eligibility Specialist II will be responsible for analyzing level II claims information to determine eligibility in the dispute resolution process in accordance with established ...

Moda Health

Supervisor, Medical Claims

Milwaukie, OR · Remote

College degree or equivalent work experience. * 2 - 4 years medical claims processing experience, including 1 year as Senior/Lead processor. * Computer proficiency in company's systems and Word and ...

Chubb

ESIS Medical Claims Analyst

Southfield, MI

Process medical only claims that are clearly work related and do not require investigation. * Process authorized payments. * Input data entry correspondence into claim system, and review files at ...

RemX

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Medical Claims Billing Specialist - REMOTE in CST - $26/hr

Omaha, NE · Remote

$26 - $28/hr

Highly respected healthcare consulting business is hiring experienced Medical Claims Billers who truly understand the why behind the claims process. This Third-Party Administrator is looking for ...

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How much do medical claims jobs pay per hour?

As of Jun 11, 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.

How to get into medical claims?

To enter the medical claims field, candidates typically need a high school diploma or equivalent, with some roles requiring postsecondary education or certifications in health insurance or medical billing. Relevant skills include attention to detail, knowledge of insurance policies, and proficiency with claims processing software. Gaining experience through internships or entry-level positions can also help establish a career in medical claims.

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.

What is the highest paying medical billing job?

The highest paying medical billing jobs are often senior roles such as Medical Billing Manager or Coding Director, which require extensive experience, certifications like CPC or CCS, and strong leadership skills. These positions typically offer higher salaries due to increased responsibilities and expertise in coding, billing processes, and compliance management.

Do I need a degree to be a claims specialist?

A degree is not always required to become a medical claims specialist, but many employers prefer candidates with a high school diploma or equivalent. Relevant skills such as knowledge of insurance procedures, attention to detail, and familiarity with claims processing software are important, and some roles may require certification or training programs.

Is it hard to get hired as a medical biller?

Getting hired as a medical biller can be competitive, but having relevant certifications, such as Certified Professional Biller (CPB), and proficiency with billing software can improve job prospects. Entry-level positions are often available, but experience and knowledge of healthcare regulations can enhance employability.
More about Medical Claims jobs
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Medical Claims jobs near you

Medical Claims Investigator

Claritev

Naperville, IL • On-site

$50/hr

Full-time

Medical, Retirement

Posted 21 days ago

Job description

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 dedication to service excellence extends to all of our stakeholders -- internal and external - driving us to consistently exceed expectations. We are intentionally bold, we foster innovation, we nurture accountability, we champion diversity, and empower each other to illuminate our collective potential.

Be part of our amazing transformational journey as we optimize the opportunity towards becoming a leading technology, data, and innovation voice in healthcare. Onward and Upward!!!

Do you know someone who you think would be a great fit for this position? To share this job with someone, click the refer-a-friend icon at the top of this page. This icon is to the right of the star icon.

JOB SUMMARY:
This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining and coordination of benefit techniques to analyze and audit hospital and physician claims to identify errant claim payments.
JOB ROLES AND RESPONSIBILITIES:
1. Achieve measured production, quality, and growth results.
2. Utilize analytics and data mining and coordination of benefits techniques to client paid claims data.
3. Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes.
4. Lookup and review medical claims in payer system to determine methods of payment and validate savings identified.
5. Promote a positive team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals.
6. Utilize official coding guidelines and resources as required, including CMS directives and bulletins.
7. Collaborate, coordinate, and communicate across disciplines and departments.
8. Ensure compliance with HIPAA regulations and requirements.
9. Demonstrate Company's Core Competencies and values held within.
10. Please note due to the exposure of PHI sensitive data, this role is considered to be a High Risk Role.
11. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
JOB SCOPE:
This role keeps the needs of external and internal customers as a priority when making decisions and taking action. Will work under direct supervision to uncover actionable claims which facilitate savings for customers. Interacts with customers and internal staff in the organization.

COMPENSATION:
The salary range for this position is $50-55K. Specific offers take into account a candidate's education, experience and skills, as well as the candidate's work location and internal equity. This position is also eligible for health insurance, 401k and bonus opportunity.

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