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Medicare Claims Representative Jobs (NOW HIRING)

Solis Health Plans

Claims Examiner

Doral, FL · On-site

$19 - $23/hr

Proficient in processing / auditing claims for Medicare plans * Follow allappropriate Federaland ... PHYSICAL DEMANDS The physical demands described here are representative of those that must be met ...

Highmark Health

Delegates assignments to appeal representatives and technical staff. Manages resources to ensure ... Identify opportunities, through the use of Medicare policies and procedures, claims processing ...

Radiant Info Systems Ltd

Claims Manager

Milwaukee, WI · On-site

The requirements listed are representative of the knowledge, skill and/or ability required ... Medicare claims), and knowledge of billing codes (CPT, ICD-9, HCPCS, RUGS, CMS and DRG pricing). A ...

Agility Billing Services

Medical Biller

Melville, NY · On-site

$26 - $28/hr

... Medicare claims from the AR team * Excellent communication skills, particularly when working with insurance representatives and internal teams * Proficient in ICD-10, CPT, and modifier usage

Highmark Health

Supervisor Appeals - Medicare

Delegatesassignments to appeal representatives and technical staff.Manages resources to ensure CMS ... Identify opportunities, through the use of Medicare policies and procedures, claims processing ...

Highmark Health

Delegates assignments to appeal representatives and technical staff. Manages resources to ensure ... Identify opportunities, through the use of Medicare policies and procedures, claims processing ...

Chubb

ESIS ProClaim Senior Representative

Plainfield, NJ · On-site

$85K - $130K/yr

ESIS ProClaim is seeking an experienced Senior Claims Representative. Reporting to the AVP and VP ... Update claims promptly with Medicare data and address Medicare reporting and interests. * Meet or ...

Peraton

Test Engineering, Senior Associate

$86K - $138K/yr

Develop, manage, and execute test cases within TestRail aligned to Medicare claims workflows and ... This represents the typical salary range for this position. Salary is determined by various factors ...

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Medicare Claims Representative information

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How much do medicare claims representative jobs pay per hour?

As of Sep 12, 2026, the average hourly pay for medicare claims representative in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

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Medicare Claims Representative jobs near you

Senior Claims Representative (Remote)

Columbia, MO • On-site, Remote

memployersmins
See more jobs at memployersminsexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 11 days ago

Job description

Are you a seasoned claims professional with a passion for navigating complex cases? MEM Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you’ll manage high-exposure workers’ compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You’ll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—all while ensuring exceptional service and regulatory compliance.
 
At MEM Insurance, we don’t just protect our customers—we empower our employees. We foster a culture of integrity, collaboration, and innovation. Our team thrives on solving challenges together, supporting one another, and making a meaningful impact in the lives of our policyholders and injured workers.
 
 
Essential Duties and Responsibilities:
Claims Handling & Administration
  • Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
  • Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
  • Oversee medical case management for catastrophic injuries and lifetime care needs.
  • Review and authorize large or complex medical bills, negotiating adjustments to control costs.
Return-to-Work Management
  • Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants.
  • Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
  • Strategically deploy investigative efforts aligned with broader claims strategy.
Claims Investigation & Loss Prevention
  • Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
  • Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
Settlements & Negotiation
  • Partner with legal teams to negotiate complex settlements and manage litigation processes.
  • Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
  • Identify opportunities for structured settlements and lead negotiations.
Reporting
  • Produce strategic reports on high-profile claims to guide management decisions.
  • Maintain system data integrity and prepare claims for Corporate Plan of Action meetings.
Collaboration
  • Lead cross-departmental efforts to improve claims handling and risk management.
  • Resolve escalated customer service issues and support high-value accounts.
  • Participate in workflow improvement initiatives and committees.
Team Leadership
  • Mentor and coach junior and intermediate adjusters.
  • Review escalated claims and provide actionable feedback.
  • Support workforce development and succession planning.
 
Qualifications:
  • Bachelor’s degree in business or related field preferred, or equivalent industry experience.
  • 7–10 years of claims handling experience, with high exposure to Workers’ Compensation.
  • Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
  • Texas All-Lines license preferred.
  • Valid driver’s license required.
 
Company Culture and Values
At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered.
 
 Connection and Belonging
MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.
 
 Total Rewards Overview
  • Health Plans: Medical, Dental, and Vision
    Includes fertility benefits, fully paid preventative care, and adult orthodontia.
  • Employer-Paid Life and Disability Benefits:
    Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
  • Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
  • Flexible Spending Account and Dependent Care options
  • Health Savings Account: Generous employer contribution.
  • Time Away from Work:
    Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
  • Employee Assistance Programs
  • 401k Retirement Plan: Employer match and profit sharing.
  • Adoption Assistance and Tuition Assistance
 
Notice Regarding Use of Artificial Intelligence
MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.

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