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Medicare Claims Processing Jobs (NOW HIRING)

Humana

Claims Processing Professional

Miramar, FL

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Humana

Claims Processing Professional

Miramar, FL

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Humana, Inc.

Claims Processing Professional

Miramar, FL · On-site

$53K - $72K/yr

As a Claims Processing Professional, you will: * Review and process healthcare claims within ... These efforts are leading to a better quality of life for people with Medicare and Medicaid ...

Radiant Info Systems Ltd

Claims Manager

Milwaukee, WI · On-site

... processing, provider relations, claims editing software and all other functionality that supports the client's Medicare and Medicaid product portfolio and administration. The manager must empower ...

UHS

Claims Auditor/Trainer

Reno, NV · On-site

... Medicare claims processing and compliance required. · QNXT system experience highly preferred. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where ...

Barrow Wise Consulting

Medicare Analyst

MD · On-site

$70K - $90K/yr

The Medicare Analyst will support Barrow Wise's Illinois DHS project and perform the following ... Document all processes and procedures and develop policies * Perform data analytics on claims and ...

Elevate Patient Financial Solutions

Medicare Specialist

$22.75 - $28.50/hr

Job Summary As a Medicare Specialist, you will be instrumental in helping resolve aged medical ... Develops a solid understanding of assigned client processes in order to review and analyze claims ...

UHS

Claims Auditor/Trainer

Reno, NV · On-site

$26.65 - $38/hr

... Medicare claims processing and compliance required. • QNXT system experience highly preferred. EEO Statement All UHS subsidiaries are committed to providing an environment of mutual respect where ...

Peraton

Enterprise Architect, Senior Advisor

$176K - $282K/yr

Architect scalable and highly available solutions for Medicare claims processing, ensuring compliance with CMS performance requirements, HIPAA security standards, and FedRAMP controls * Configure and ...

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Medicare Claims Processing information

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$12

$19

$26

How much do medicare claims processing jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for medicare claims processing in the United States is $19.16, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.67 per hour, depending on experience, location, and employer.

What is Medicare claims processing?

Medicare claims processing refers to the series of steps involved in reviewing, approving, and paying claims for healthcare services provided to Medicare beneficiaries. This process ensures that submitted claims meet Medicare’s rules and regulations and that providers are reimbursed correctly. Claims processors review documentation, verify patient eligibility, check for coding accuracy, and determine coverage based on Medicare guidelines. The process helps to prevent fraud, waste, and abuse while ensuring timely payment to healthcare providers.

What are the key skills and qualifications needed to thrive in Medicare claims processing, and why are they important?

To excel in Medicare Claims Processing, you need strong attention to detail, knowledge of healthcare billing procedures, and familiarity with Medicare regulations, often supported by experience or coursework in medical billing and coding. Proficiency with claims management software, electronic health record (EHR) systems, and understanding of ICD-10 and CPT coding are typically required. Excellent organizational skills, problem-solving abilities, and clear communication help professionals navigate complex claims and resolve issues efficiently. These skills ensure accurate, timely claims processing, minimize errors, and support compliance with Medicare guidelines, ultimately benefiting both providers and patients.

What are some common challenges faced in Medicare claims processing and how can I prepare for them?

Medicare claims processing specialists often encounter challenges such as navigating complex regulations, ensuring timely and accurate data entry, and resolving discrepancies or denials from insurance payers. To prepare, it's helpful to develop strong attention to detail, stay up to date on Medicare guidelines, and become proficient with claims management software. Regular communication with healthcare providers and insurance representatives is also crucial for resolving issues efficiently and ensuring claims are processed correctly.

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

AspectMedicare Claims ProcessingMedical Billing Specialist
CertificationsTypically requires claims processing training, possibly some Medicare-specific certificationsOften requires medical billing and coding certifications, such as CPC or CMA
Work EnvironmentHealthcare facilities, insurance companies, government agenciesMedical offices, clinics, healthcare billing companies
Job FocusReviewing, submitting, and managing Medicare claims for reimbursementPreparing and submitting medical bills to various insurance providers, including Medicare

Medicare Claims Processing involves handling Medicare-specific claims, ensuring compliance with government regulations. Medical Billing Specialists manage billing for various insurance types, including Medicare, focusing on accurate coding and documentation. While both roles require knowledge of healthcare billing, Medicare Claims Processing is more specialized in Medicare procedures and regulations.

How to get a job as a Medicare claims processor?

To become a Medicare claims processor, candidates typically need a high school diploma or equivalent, with some roles requiring postsecondary education or training in healthcare administration. Relevant skills include attention to detail, knowledge of medical billing and coding, and familiarity with claims processing software. Certification in medical billing or coding can improve job prospects, and positions often require working in a healthcare or administrative environment with standard office hours.

Is Medicare claims processing a stressful job?

Medicare claims processing can be stressful due to strict deadlines, high accuracy requirements, and the need to handle complex regulations. Employees often work in fast-paced environments and must pay close attention to detail, which can contribute to job-related stress.

Is a Medicare Claims Processing job in demand?

Medicare Claims Processing jobs are in demand due to the ongoing need for healthcare administration and the aging population. These roles often require knowledge of healthcare policies and claims software, and employment is expected to grow as healthcare services expand and evolve.
More about Medicare Claims Processing jobs

What are the most commonly searched types of Medicare Claims Processing jobs?

The most popular types of Medicare Claims Processing jobs are:

What states have the most Medicare Claims Processing jobs?

States with the most job openings for Medicare Claims Processing jobs include:

What job categories do people searching Medicare Claims Processing jobs look for?

The top searched job categories for Medicare Claims Processing jobs are:

Medicare Claims Processing jobs near you
Infographic showing various Medicare Claims Processing job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $39,863 per year, or $19.2 per hour.

Healthcare Claims Operations Team Lead - Washington, DC (On-site)

Gainwell Technologies

Washington, DC • On-site

$50K - $55K/yr

Full-time

Medical, Life, Retirement, PTO

Re-posted 15 days ago

Gainwell Technologies rating

7.8

Company rating: 7.8 out of 10

Based on 80 frontline employees who took The Breakroom Quiz

137th of 245 rated software companies

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.
Summary
As a Healthcare Claims Operations Team Lead at Gainwell, you will lead a team responsible for medical claims processing, resolution, and financial reconciliation supporting Medicaid and Medicare programs.
You will oversee end-to-end healthcare claims operations, including claims adjudication, complex issue resolution, payment accuracy, and compliance with CMS guidelines. This role serves as a subject matter expert in health insurance claims workflows and financial processes, while driving operational efficiency, quality, and continuous improvement.
Your role in our mission
  • Lead, mentor, and develop a team supporting medical claims processing, adjudication, and resolution
  • Oversee the full lifecycle of healthcare claims, ensuring accuracy, timeliness, and service excellence
  • Resolve complex and escalated Medicaid and Medicare claims issues, including discrepancies and exceptions
  • Manage claims-related financial processes, including payments, reimbursements, adjustments, and reconciliations
  • Partner with cross-functional teams across finance, compliance, IT, and operations to optimize workflows and performance

What we're looking for
  • 5-7+ years of experience in medical claims, healthcare claims, or health insurance operations
  • Strong experience working with Medicaid and/or Medicare claims
  • Experience with end-to-end claims lifecycle, including adjudication, processing, and resolution
  • Knowledge of claims-related financial processes, including reconciliation, payments, and adjustments
  • Proven experience leading or supervising teams in a healthcare claims or insurance environment

What you should expect in this role
  • Onsite position located at Gainwell Technologies, 1111 19th St NW, Suite 1000, Washington, DC
  • Opportunity to lead high-impact healthcare claims operations supporting government-sponsored programs
  • A collaborative environment focused on operational excellence, compliance, and continuous improvement
  • Career growth within a company that values innovation, flexibility, and professional development
  • Exposure to cross-functional leadership and strategic initiatives across claims, finance, and compliance teams

*This posting is intended for pipelining. We will accept applications on an ongoing basis.
#LI-ONSITE
#LI-LS2
The pay range for this position is $50,000 - $55,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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