... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... healthcare claims processing -OR- * An approved equivalent combination of education and experience Knowledge/ Skills/ Abilities: * Excellent problem solving skills * Knowledge of EPIC claims ...
... healthcare claims processing -OR- * An approved equivalent combination of education and experience Knowledge/ Skills/ Abilities: * Excellent problem solving skills * Knowledge of EPIC claims ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Mount Pleasant, SC · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Mount Pleasant, SC · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Claims Audit Coordinator
$24 - $28/hr
Minimum of 3 years of experience in claims processing, preferably within a managed care or health plan setting. Experience in auditing claims or working in a quality assurance capacity within a ...
Claims Audit Coordinator
$24 - $28/hr
Minimum of 3 years of experience in claims processing, preferably within a managed care or health plan setting. Experience in auditing claims or working in a quality assurance capacity within a ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Bowling Green, KY · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Bowling Green, KY · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Jacksonville, FL · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Jacksonville, FL · Remote
... claims trends, payment integrity issues, and process gaps. Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment ...
Senior Health Analytics Consultant with Security Clearance
Washington, DC · Hybrid
$115K - $139K/yr
US Citizen Responsibilities Conduct Medicare claims analysis and policy research Develop and verify ... of healthcare data structures and claims processing Preferred Qualifications Advanced degrees ...
New
Senior Health Analytics Consultant with Security Clearance
Washington, DC · Hybrid
$115K - $139K/yr
US Citizen Responsibilities Conduct Medicare claims analysis and policy research Develop and verify ... of healthcare data structures and claims processing Preferred Qualifications Advanced degrees ...
New
Senior Claims Examiner, Healthcare
Atlanta, GA · On-site
$120K - $150K/yr
Conduct, coordinate, and proactively handle the investigation process and ensures timely resolution ... claims. * 5-10 plus years of healthcare claim handling experience or matching equivalency.
Quick apply
Senior Claims Examiner, Healthcare
Atlanta, GA · On-site
$120K - $150K/yr
Conduct, coordinate, and proactively handle the investigation process and ensures timely resolution ... claims. * 5-10 plus years of healthcare claim handling experience or matching equivalency.
Senior Claims Examiner, Healthcare
Manhattan, NY · On-site
$120K - $150K/yr
Conduct, coordinate, and proactively handle the investigation process and ensures timely resolution ... claims. * 5-10 plus years of healthcare claim handling experience or matching equivalency.
Quick apply
Senior Claims Examiner, Healthcare
Manhattan, NY · On-site
$120K - $150K/yr
Conduct, coordinate, and proactively handle the investigation process and ensures timely resolution ... claims. * 5-10 plus years of healthcare claim handling experience or matching equivalency.
Us Healthcare Claims Processing information
See salary details
$12.02 - $13.33
2% of jobs
$13.33 - $14.64
6% of jobs
$14.64 - $15.95
9% of jobs
$16.63 is the 25th percentile. Wages below this are outliers.
$15.95 - $17.26
14% of jobs
$17.26 - $18.58
18% of jobs
The median wage is $18.62 / hr.
$18.58 - $19.89
17% of jobs
$20.61 is the 75th percentile. Wages above this are outliers.
$19.89 - $21.20
16% of jobs
$21.20 - $22.51
7% of jobs
$22.51 - $23.82
4% of jobs
$23.82 - $25.13
4% of jobs
$25.13 - $26.44
2% of jobs
$12
$19
$26
How much do us healthcare claims processing jobs pay per hour?
As of Jun 12, 2026, the average hourly pay for us healthcare 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.
How much do claims processors make in the US?
Claims processors in the US typically earn a median annual salary of around $40,000 to $45,000. Experienced claims processors with certifications or specialized skills can earn higher wages, often exceeding $50,000 annually. Salaries vary based on location, experience, and employer size.
What is the difference between Us Healthcare Claims Processing vs Medical Billing Specialist?
| Aspect | Us Healthcare Claims Processing | Medical Billing Specialist |
|---|---|---|
| Certifications | CPHIMS, CPC, or similar | CPC, CCS, or similar |
| Work Environment | Healthcare providers, insurance companies | Medical offices, billing companies |
| Primary Focus | Submitting and managing insurance claims | Creating and sending patient bills |
Us Healthcare Claims Processing involves managing insurance claims submissions and follow-ups, while Medical Billing Specialists focus on generating patient bills and ensuring accurate invoicing. Both roles require similar certifications and often work in healthcare settings, but their core responsibilities differ in claim management versus billing creation.
How to become a health insurance claims processor?
To become a health insurance claims processor, typically one needs a high school diploma or equivalent, along with training in medical billing and coding. Many employers prefer candidates with certification in medical billing or coding, and proficiency with claims processing software is beneficial. On-the-job training is common, and strong attention to detail and knowledge of healthcare regulations are important for success.
Is a claims processor job in demand?
Claims processor jobs in healthcare are in steady demand due to the ongoing need for insurance claims management and administrative support. The role often requires familiarity with claims processing software and knowledge of healthcare regulations, and employment is expected to grow as healthcare services expand.
Do you need a degree to be a claims processor?
For a healthcare claims processing role, a formal degree is not typically required, but employers often prefer candidates with a high school diploma or equivalent. Relevant skills include attention to detail, knowledge of medical billing and coding, and familiarity with claims processing software; certifications like CPC can enhance job prospects.
Lead Overpayment Recovery Analyst, Payment Integrity - Health Plan (Remote)
Passport Health Plan by Molina HealthcareMadison, WI • Remote
Full-time
Posted 23 days ago
Job description
JOB DESCRIPTION Job Summary
Provides lead level analyst support for health plan payment integrity activities. Partners with leaders and functional representatives to drive health plan financial performance through evaluation and execution of operational initiatives tied to payment integrity (PI) and provider claims accuracy. Makes recommendations that inform decisions which contribute to health plan strategy, and acts as a trusted voice in assessing and assisting resolution of complex business challenges that impact cost-containment and regulatory compliance.
Essential Job Duties
Business Leadership & Operational Ownership
Assists with and executes projects and tasks to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for pre-pay edits, post-payment datamining, and overpayment recovery, to improve encounter submissions, reduce general and administrative (G&A) expenses, and drive positive operational and financial outcomes for all payment integrity (PI) solutions.
Manages scorable action items (SAIs) related to pre-pay editing, post-pay audit, and overpayment recovery initiatives to ensure health plan SAI targets are met.
Leads efforts to improve claim payment accuracy and financial performance without needing extensive oversight.
Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
Serves as a thought partner to health plan leadership and provides well-reasoned recommendations that support short- and long-term business goals.
Partners with the network team to communicate recovery projects to ensure provider relations is informed and able to respond to provider inquiries.
- Analyze data to identify and develop new recovery opportunities
- Analyze data from Payment Integrity and Vendors against contracts, billing, and processing guidelines
- Collaborates with operational teams, enterprise stakeholders, and finance partners to proactively identify issues and implement resolution strategies.
- Conduct peer reviews of recovery concepts and offer recommendations for logical improvements; assist team members in their analysis of data sets and trends.
- Responsible for documenting policies and procedures related to concept approvals
- Conduct trainings and prepare training documentation for teams
- Other duties as assigned
Strategic Business Analysis
Uses a business lens to ensure accurate interpretation of provider claims trends, payment integrity issues, and process gaps.
Applies understanding of health care regulations, managed care claims workflows, and provider reimbursement models to shape payment integrity related recommendations and action plans.
Translates strategic needs into clear requirements, workflows, and solutions that drive measurable improvement.
Partners with finance and compliance to develop business cases and support reporting that ties operational outcomes to financial targets.
Applied Analytical Support
Uses data analysis tools/systems to support business analysis.
Validates findings and tests assumptions through data, and leads with contextual knowledge of claims processing, provider contracts, and operational realities.
Creates succinct summaries and visualizations that enable faster leadership decision-making.
Required Qualifications
At least 4 years of business analyst experience in a managed care organization (MCO), and at least 2 years of experience in Medicaid and/or Medicare programs, or equivalent combination of relevant education and experience.
Proven experience owning operational projects from concept to execution, especially in the areas of provider reimbursement and claims payment integrity.
Strong working knowledge of managed care claims coding (Current Procedural Terminology (CPT), International Classification of Diseases (ICD), Healthcare Common Procedure Coding System (HCPCS), Revenue Codes), and federal/state Medicaid payment rules.
Strong data analysis/queries experience, and ability to analyze data to inform business decisions.
Strong business judgment, cross-functional coordination, and ownership of high-value deliverables.
Demonstrated ability to work independently and apply business judgment in a highly regulated, cross-functional environment.
Strong written and verbal communication skills, including ability to synthesize complex information.
Microsoft Office suite (including advanced Excel), and applicable software program(s) proficiency.
- Claims processing background
- Experience with Medicare, Medicaid, and/or Marketplace lines of business.
- Payment integrity (PI) programs
Preferred Qualifications
Experience with Medicare, Medicaid, and/or Marketplace lines of business.
Certified Business Analysis Professional (CBAP) or Certified Coding Specialist (CCS) certification.
Project management experience.
Familiarity with Medicaid-specific scorable action items (SAIs), operational cost-management efforts, payment integrity (PI) programs, and regulatory/compliance adherence.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $83,252 - $155,508 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.