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Claims Specialist (278635)

Durham, NC · On-site

$18 - $20/hr

In this role, you will review, process, adjust, and resolve medical insurance claims while ensuring accuracy, compliance, and timely payment. You will collaborate with internal teams, healthcare ...

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How much do medical insurance claims jobs pay per hour?

As of Jul 20, 2026, the average hourly pay for medical insurance claims in the United States is $20.97, according to ZipRecruiter salary data. Most workers in this role earn between $17.31 and $23.08 per hour, depending on experience, location, and employer.

How do I become a medical claims adjuster?

To become a medical claims adjuster, you typically need a high school diploma or equivalent, and some states require a license which involves passing a state exam. Relevant skills include attention to detail, knowledge of insurance policies, and familiarity with medical terminology; obtaining a certification such as the Certified Professional Coder (CPC) can enhance job prospects.

What is the highest paid insurance adjuster?

Senior medical insurance claims adjusters or those with extensive experience and specialized certifications can earn salaries exceeding $80,000 annually, with top earners reaching over $100,000. Factors influencing pay include location, employer size, and individual expertise in complex claims processing and negotiation.

What are the key skills and qualifications needed to thrive in the Medical Insurance Claims position, and why are they important?

To thrive in Medical Insurance Claims, a strong understanding of healthcare billing, insurance policies, and claims processing procedures is essential, typically supported by a diploma or relevant experience in medical administration. Familiarity with claims management software, medical coding systems (such as ICD-10 and CPT), and knowledge of HIPAA regulations is commonly required. Attention to detail, problem-solving skills, and effective written and verbal communication help individuals excel in this role. These competencies ensure timely, accurate claims processing and positive working relationships with providers, insurers, and patients.

What is a Medical Insurance Claims job?

A Medical Insurance Claims job involves processing and reviewing insurance claims submitted by healthcare providers or patients. Professionals in this role assess claims for accuracy, verify patient coverage, and determine the amount payable by the insurance company. They may also communicate with healthcare providers, policyholders, and adjusters to resolve discrepancies and ensure proper claim adjudication. Strong attention to detail and knowledge of medical billing codes and insurance policies are essential for success in this field.

What are the typical daily responsibilities of someone working in Medical Insurance Claims?

Professionals in Medical Insurance Claims are responsible for reviewing and processing insurance claims submitted by healthcare providers or patients, verifying the accuracy of billing information, and ensuring compliance with policy guidelines. They regularly communicate with insurance companies, medical offices, and occasionally patients to resolve discrepancies or request additional information. The role involves considerable attention to documentation, data entry, and adhering to deadlines to expedite claim decisions. Teamwork is often essential, as collaboration with billing specialists and other administrative staff helps streamline claim resolution and maintain efficient workflow.

What health insurance company pays the most claims?

Medical insurance claims professionals work with various insurance providers, but the amount of claims paid depends on the company's size, policy coverage, and claim volume. Larger insurers like UnitedHealthcare, Anthem, and Cigna process the highest total claims due to their extensive customer bases. The role requires knowledge of claims processing systems and industry regulations.

How to start a career in insurance claims?

To start a career in medical insurance claims, obtain a high school diploma or equivalent, and consider pursuing relevant certifications such as the Certified Professional Coder (CPC) or claims processing courses. Entry-level roles often require strong attention to detail, knowledge of insurance policies, and proficiency with claims processing software, with opportunities for advancement through experience and additional training.
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Medical Insurance Claims jobs near you

Medical Billing / Insurance Claims Specialist

PHA Health

Mccook, NE • On-site

$16.50 - $22/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 9 days ago

Job description

PHA Health specializes in providing high-quality, low-cost healthcare to members through our benefit plans. Our commitment to our team and clients is to provide a benefit plan for employers and their employees that is sustainable, affordable, and promotes well-being. Our team members must possess the company's core values:

  • Put People First
  • Do the Right Thing
  • Be Humbly Confident
  • Be Resilient

PHA Health is looking for a full-time Medical Billing / Insurance Claims Specialist.

Essential Duties and Responsibilities:

  • Answer member benefit questions
  • Review member EOB's and member bills to ensure accurate processing
  • Work closely with TPAs for claim processing issues
  • Assist provider offices and facilities with claims status questions
  • Data Entry
  • Filter/disperse incoming claims to appropriate TPAs
  • Create and track invoices
  • Respond to calls and emails in a timely manner
  • Provide excellent customer service

Pay: DOE

Work Location: In person or remote

Job type: Full-Time day shift Monday through Friday

Benefits

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Vision insurance
  • AFLAC benefit package
  • Paid time off