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Medical Insurance Claims Processor Jobs in Georgia

HealthONE

Claims Processor II

Dalton, GA · On-site

$15 - $19/hr

Claims Processor II Our mission is to enhance well-being by connecting individuals with vital ... Medical Insurance * Paid Time Off * Pet Insurance * Short Term Disability * Vision Insurance Pre ...

HealthOne Alliance

Claims Processor II

Dalton, GA · On-site

$15 - $19/hr

... medical claims pended for manual adjudication in assigned Workflow roles. The Claims Processor II will accurately interpret benefit and policy provisions applicable to fully-insured plan members and ...

HealthOne Alliance

Claims Processor II

Dalton, GA · On-site

$15 - $19/hr

... medical claims pended for manual adjudication in assigned Workflow roles. The Claims Processor II will accurately interpret benefit and policy provisions applicable to fully-insured plan members and ...

HealthOne Alliance

Claims Processor II

Dalton, GA · On-site

$15 - $19/hr

... medical claims pended for manual adjudication in assigned Workflow roles. The Claims Processor II will accurately interpret benefit and policy provisions applicable to fully-insured plan members and ...

Karna, LLC

$20 - $25/hr

Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance ... Understanding of medical terminology, healthcare services, and insurance procedures (worker ...

KARNA LLC

$20 - $25/hr

Understanding of medical terminology, healthcare services, and insurance procedures (worker ... appeals process. * Ability to efficiently manage a high volume of claims. * Customer service ...

Parker's Kitchen

Claims Specialist

Savannah, GA · On-site

Notify insurance carriers of new claims and serve as the primary point of contact throughout the ... process, including coordinating return-to-work efforts with managers, medical providers, and Human ...

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Medical Insurance Claims Processor information

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How much do medical insurance claims processor jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for medical insurance claims processor in Georgia is $17.77, according to ZipRecruiter salary data. Most workers in this role earn between $13.80 and $20.10 per hour, depending on experience, location, and employer.

What does a medical insurance claims processor do?

A Medical Insurance Claims Processor reviews and processes insurance claims submitted by healthcare providers or patients. They verify the accuracy of claim information, ensure services are covered by the patient’s insurance policy, and calculate the payment amounts. Claims processors also communicate with providers and policyholders to resolve discrepancies or request additional information when necessary. Their work helps ensure timely and accurate reimbursement for medical services.

What are the key skills and qualifications needed to thrive as a medical insurance claims processor?

To thrive as a Medical Insurance Claims Processor, you need a solid understanding of medical terminology, health insurance policies, and claims processing procedures, typically supported by a high school diploma or associate degree. Familiarity with claims management software, coding systems like ICD-10 and CPT, and electronic health record (EHR) platforms is essential. Attention to detail, analytical thinking, and strong communication skills help ensure accuracy and efficiency when handling sensitive information and resolving claim issues. These skills are crucial for minimizing errors, expediting claims resolution, and maintaining compliance with industry regulations.

What are some common challenges faced by medical insurance claims processors, and how can they be managed?

Medical Insurance Claims Processors often encounter challenges such as navigating complex insurance policies, dealing with frequent policy changes, and communicating with both providers and patients to resolve discrepancies. Staying organized and detail-oriented is crucial, as missing documentation or incorrect coding can delay claim approvals. Regularly attending training sessions on insurance regulations and collaborating closely with billing teams can help manage these challenges and ensure accurate, timely claim processing.

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

AspectMedical Insurance Claims ProcessorMedical Billing Specialist
CredentialsHigh school diploma; certifications like CPC or CPC-HHigh school diploma; certifications like CPC or CPC-H
Work EnvironmentHealthcare offices, insurance companiesHealthcare offices, billing departments
Primary ResponsibilitiesReview and process insurance claims, ensure accuracyGenerate bills, follow up on payments, manage accounts

While both roles involve healthcare billing and insurance, Medical Insurance Claims Processors focus on reviewing and submitting insurance claims, ensuring they are correctly processed. Medical Billing Specialists handle the entire billing cycle, including generating invoices and managing payments. Both roles require similar certifications and often work in healthcare or insurance settings, but their core functions differ in scope and daily tasks.

How to become a medical insurance claims processor?

To become a medical insurance claims processor, typically one needs a high school diploma or equivalent, along with training in healthcare billing and coding. Many employers prefer candidates with knowledge of medical terminology, insurance policies, and experience with claims processing software; certifications such as Certified Professional Coder (CPC) can also enhance job prospects.

Is a medical insurance claims processor job in demand?

The demand for medical insurance claims processors remains steady due to ongoing healthcare industry needs and the increasing complexity of insurance claims. Employment in this field is expected to grow as healthcare providers and insurers seek skilled workers familiar with claims processing software and regulations. Certification and experience can enhance job prospects in this role.

What are popular job titles related to Medical Insurance Claims Processor jobs in Georgia?

For Medical Insurance Claims Processor jobs in Georgia, the most frequently searched job titles are:

What job categories do people searching Medical Insurance Claims Processor jobs in Georgia look for?

The top searched job categories for Medical Insurance Claims Processor jobs in Georgia are:

What cities in Georgia are hiring for Medical Insurance Claims Processor jobs?

Cities in Georgia with the most Medical Insurance Claims Processor job openings:

What are popular job titles related to Medical Insurance Claims Processor jobs in GA?

For Medical Insurance Claims Processor jobs in GA, the most frequently searched job titles are:

Medical Insurance Claims Processor jobs near you
Infographic showing various Medical Insurance Claims Processor job openings in Georgia as of August 2026, with employment types broken down into 1% As Needed, 70% Full Time, 15% Part Time, 11% Contract, and 3% Nights. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $36,953 per year, or $17.8 per hour.

Claims Processor II

HealthONE

Dalton, GA • On-site

$15 - $19/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

Claims Processor II

Our mission is to enhance well-being by connecting individuals with vital health resources through a compassionate workforce that embodies the spirit of neighbors helping neighbors. HealthOne is guided by a cultural framework that embodies our values and drives our decisions. As a company our purpose is to care for people by connecting them to resources that help protect them in health related situations. We fulfill our purpose by filtering our decisions through a lens of asking, "Is what we are about to do ethical, empathetic, economical, and efficient?". By caring for people, we are welcoming, authentic, truthful, consistent, and humble. We are continuously looking for ways to improve our process and how we get things done. HealthOne seeks individuals with integrity and heart to embody our values. Whether you're starting your career or looking to develop additional skills to reach your full potential, HealthOne provides the means to help you achieve your goals.

Job Purpose: The Claims Processor II is responsible for accurate and timely processing of both professional and institutional medical claims pended for manual adjudication in assigned Workflow roles. The Claims Processor II will accurately interpret benefit and policy provisions applicable to fully-insured plan members and review claims to determine coverage based on contract, provider status, and claims processing guidelines. The incumbent must meet quality and productivity standards.

Essential Job Duties:

  • Reviews and adjudicates claims up to specified dollar limits
  • Processes claims within performance guidelines of the department, including quality and timeliness
  • Works with and understands Company benefit plans
  • Understands provider contracts
  • Examines and interprets all relevant documents included with the claims
  • Responds to claim-specific questions, as applicable
  • Partners with leadership on any questionable claim activity
  • Understands logic of standard medical coding (i.e. CPT, ICD-10, HCPCS, etc.)
  • Determines accurate payment criteria for clearing pended claims based on defined Policy and Procedures
  • Researches claim edits to determine appropriate benefit application utilizing established criteria, applies physician contract pricing as needed for claims
  • Works high volume of repetitive claims
  • Identifies claims with inaccurate data or claims that require review by appropriate team members
  • Contributes positively as a team player
  • Completes special projects as assigned and supports other Claims Department team members in assigned projects
  • Complies with all departmental and Company policies and procedures
  • Maintains regular and predictable attendance
  • Consistently demonstrates compliance with HIPAA regulations, professional conduct, and ethical practice
  • Works to encourage and promote Company culture throughout the organization
  • Other duties as may be assigned

Qualifications:

  • High School Diploma or GED required
  • Associates or Bachelor's Degree preferred
  • A minimum of one year experience in claims processing required, must include Professional and Institutional processing; previous experience in medical billing and coding required if no claims processing experience
  • Knowledge of ICD-10, CPT4, DRG, HCPCS codes, medical terminology, EDI and HIPAA protocols preferred
  • Knowledge of UB and HCFA 1500 forms
  • Certified Professional Coder (CPC) preferred
  • Experience with Word and Excel

Physical Requirements:

  • Prolonged periods of sitting at a desk and working on a computer
  • Moderate to significant amount of stress in meeting deadlines and dealing with day-to-day responsibilities
  • Must be able to drive a vehicle and daytime/overnight travel as required

Benefits:

  • 401K (4% Match, Immediate Vesting)
  • Accident insurance
  • Competitive salary
  • Critical Illness Insurance
  • Dental Insurance
  • Employee Assistance Program
  • Flexible Spending Account
  • Health & Wellness Program
  • Health Savings Account
  • Life & AD&D Insurance
  • Long Term Disability
  • Medical Insurance
  • Paid Time Off
  • Pet Insurance
  • Short Term Disability
  • Vision Insurance

Pre-Employment Screening: Drug Screen and Background Check Required

HealthOne is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, disability, sex, age, ethnic or national origin, marital status, sexual orientation, gender identity or presentation, pregnancy, genetics, veteran status or any other status protected by state or federal law.

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