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Medical Insurance Claims Processor Jobs in Houston, TX

PFS Group

Follow up Insurance Representative

Houston, TX · On-site

$37K - $45K/yr

This role involves evaluating and processing insurance claims, providing expert advice to clients ... medical bills with clarity and care. We deliver exceptional customer service on behalf of health ...

PFS Group

Remote Insurance Rep

Houston, TX · Remote

$53K - $67K/yr

Strong understanding of insurance policies, coverage, claims processes, and reimbursement, with the ability to research payer billing policies and medical bulletins to accurately troubleshoot denials ...

PFS Group

Remote Insurance Rep

Houston, TX · On-site +1

$53K - $67K/yr

Strong understanding of insurance policies, coverage, claims processes, and reimbursement, with the ability to research payer billing policies and medical bulletins to accurately troubleshoot denials ...

PFS Group

Remote Senior Insurance Rep

Houston, TX · On-site +1

Key Responsibilities: - Manage and process insurance claims, ensuring accuracy and timeliness in accordance with company policies and industry regulations. - Serve as a primary point of contact for ...

PFS Group

Remote Senior Insurance Rep

Houston, TX · On-site +1

Key Responsibilities: - Manage and process insurance claims, ensuring accuracy and timeliness in accordance with company policies and industry regulations. - Serve as a primary point of contact for ...

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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 10, 2026, the average hourly pay for medical insurance claims processor in Houston, TX is $20.09, according to ZipRecruiter salary data. Most workers in this role earn between $15.62 and $22.74 per hour, depending on experience, location, and employer.

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.

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 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 popular job titles related to Medical Insurance Claims Processor jobs in Houston, TX? For Medical Insurance Claims Processor jobs in Houston, TX, the most frequently searched job titles are:
What job categories do people searching Medical Insurance Claims Processor jobs in Houston, TX look for? The top searched job categories for Medical Insurance Claims Processor jobs in Houston, TX are:
Medical Insurance Claims Processor jobs near you
Infographic showing various Medical Insurance Claims Processor job openings in Houston, TX as of August 2026, with employment types broken down into 1% As Needed, 82% Full Time, 12% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $41,792 per year, or $20.1 per hour.

Workflow Specialist Claims Processing

Tata Consultancy Services

Cypress, TX • On-site

$50K - $53K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 28 days ago

Tata Consultancy Services rating

6.5

Company rating: 6.5 out of 10

Based on 21 frontline employees who took The Breakroom Quiz

173rd of 223 rated it services

Job description

Responsibilities:
To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
Approval or denial on FMLA claims as per Insurance carrier, and employers guidelines
Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
Refers cases as appropriate to team lead and clinical case management
Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
Provide ideas to management on continuous improvement and service level management
Performs other duties or participates in special projects as assigned
Requirements:
1+ year of Disability/FMLA/PFL claims or insurance claims experience
Experience working with FINEOS
Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
Excellent oral and written communication, including presentation skills
Strong Analytical, decision making, problem solving, and people management skills
Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
Willingness to embrace change in a fast paced work environment
A strong desire to continuously learn and improve
Identify escalated cases and work with Team Leader to develop a plan to address key issues.
TCS Employee Benefits Summary:
• Discretionary Annual Incentive.
• Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
• Family Support: Maternal & Parental Leaves.
• Insurance Options: Auto & Home Insurance, Identity Theft Protection.
• Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement.
• Time Off: Vacation, Time Off, Sick Leave & Holidays.
• Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
Salary Ran ge: $50,000 - $53,000 per year

What Tata Consultancy Services employees say

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About Tata Consultancy Services

Sourced by ZipRecruiter

Tata Consultancy Services is an IT services, consulting and business solutions organization that delivers real results to global business, ensuring a level of certainty no other firm can match. TCS offers a consulting-led, integrated portfolio of IT, BPO, infrastructure, engineering, and assurance services. This is delivered through its unique Global Network Delivery Model™, recognized as the benchmark of excellence in software development. TCS delivers a level of certainty that no other firm can match--to our clients and to our employees. Come join us and experience certainty in your career. TCS a global Consulting and IT Services firm that is ranked in the top quartile by industry analysts. Our 2021 fiscal revenues topped $25 B and our market capitalization is over $170+B, yet we have a deep and large history of philanthropy and corporate social responsibility. Now approaching 600K of the best IT professionals and consultants, we are a trusted advisor, guiding our clients' enterprises through growth and transformation journeys - helping them to become agile, intelligent, automated and on the cloud. We are devoted to DEI and are recognized as a top employer and place to work.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Edison, NJ, US

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