Medical Claims Processing jobs Skill: Medical Claims Processing Senior Claim Benefit Specialist Operations (Encounters)
CVS Health · Remote, US· Remote · Full-time · Senior
Patient Access Concierge - Outpatient Vascular Surgery Office - Latham
Holy Cross Health · Latham, US· Full-time
Claims Processing Tech - Eddy Senior Care
Holy Cross Health · Troy, US· On-site · Full-time
Accounts Payable Representative
Chapters Health System · Temple Terrace, US· Hybrid
Revenue Cycle Specialist II Hybrid
University Hospitals · Shaker Heights, USHybrid · Full-time
Medical Claims Examiner
TEKsystems · Fairfield, US+1 more · On-site · Contract · Associate
Claims Processor
TEKsystems · Remote, US+3 more · Remote · Contract
Medical Claims Processor
TEKsystems · Milwaukee, US· On-site · Contract
Appeals Specialist (Medical Claims)
Northwest Administrators, Inc. · Seattle, US+2 more · Hybrid · Full-time
Appeals Specialist (Medical Claims)
Northwest Administrators, Inc. · Seattle, US+2 more · Hybrid · Full-time
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CVS Health · Posted Nov 9, 2026
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Researches, reviews, and adjudicates complex, sensitive, and specialized encounters in accordance with state-specific processing guidelines.
Drive timely resolution of encounter errors using available resources, tools, and research. Adjudicate complex, sensitive, and specialized claims with accuracy in the claims processing system. Consistently meet quality and production expectations. Identify and escape issues that impact claim payment accuracy or create rework. Partner cross-functionally to resolve barriers to encounter acceptance. High School Diploma Nice to have: QNXT Nice to have: Facets Nice to have: Medicaid Nice to have: Medicare medical dental vision coverage paid time off retirement savings options Holy Cross Health · Posted Oct 26, 2026
Patient Access Concierge in an outpatient vascular surgery office, responsible for patient registration, scheduling, insurance verification, payment processing, and related administrative tasks.
Pay Range: $18.00 - $24.27
Verifies patient identification, demographic information, and insurance coverage Accepts point of service payments Enters patient information accurately into appropriate hospital information system(s) Refers patients with questions regarding financial liability to appropriate resource(s) Accepts medical authorization or referral forms, if appropriate High school diploma Associate degree (preferred) Nice to have: customer service experience in another industry Nice to have: knowledge of insurance and governmental programs, regulations and billing processes (Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability) Nice to have: managed care contracts Holy Cross Health · Posted Oct 16, 2026
Enter patient claims into the system, adjudicate, resolve discrepancies, and communicate with providers to ensure accurate and timely payment.
Pay range: $18.50-$24.66. Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location
Process billing for self‑pay clients and contracted agencies Obtain and manage service authorizations Prepare, review, and submit invoices and claims Monitor and reconcile cash postings Follow up on outstanding account balances to ensure timely resolution High School Diploma Nice to have: prior authorization and/or billing is preferred Chapters Health System · Posted Sep 8, 2026
Responsible for ensuring accurate payments to vendors/providers and managing invoice and claim processing.
Compensation Pay Range: $18.43 - $27.43
Process invoices and check requests using automated AP system Enter vouchers into AP system and review for accuracy Assign correct affiliate/GL account coding to each voucher Assign approver and submit for approval Add vouchers requiring special attention to the special handling log Nice to have: Medical Claims Processing Nice to have: Medical Biller Nice to have: Medical Coder University Hospitals · Posted Nov 7, 2026
Responsible for submitting and resolving medical claims of moderate to high complexity for inpatient and outpatient claims.
Responds to requests from management, staff, or physicians in a timely and appropriate manner Maintains patient and physician confidentiality and professionalism at all times Follow department policies and procedures to ensure accurate and timely claim resolution Effectively communicates utilizing telephone, form letters, e-mail, or internal correspondence to resolve patient inquiries and insurance issues Attends and participates in team meetings TEKsystems · Posted Oct 21, 2026
Review, research, and process Medi-Cal claims while ensuring accuracy, quality, and compliance with established guidelines.
Fairfield, California, United States Redding, California, United States Review, research, and resolve pended Medi-Cal claims Process claims and claims-related worksheets accurately and efficiently Investigate claim issues and determine appropriate resolutions Route claims to internal departments when additional review is needed and follow up to ensure timely completion Generate provider correspondence and documentation related to claim processing Nice to have: CPT coding Nice to have: ICD-10 coding Nice to have: Experience processing Medi-Cal claims Nice to have: Healthcare, health plan, TPA, or insurance industry experience TEKsystems · Posted Oct 29, 2026
We are seeking an experienced Claims Analyst to join a growing healthcare operations team. This position is responsible for reviewing, analyzing, and adjudicating medical claims while ensuring compliance with benefit plans, medical policies, and established processing guidelines.
Wisconsin, United States Waukesha, Wisconsin, United States Menasha, Wisconsin, United States Brookfield, Wisconsin, United States Pay Rate: $19.25/hour. The pay range for this position is $19.25 - $19.25/hr.
Review and adjudicate paper and electronic medical claims. TEKsystems · Posted Nov 4, 2026
Process and adjudicate medical claims for a healthcare insurance organization.
The pay range for this position is $19.25 - $22.00/hr.
Adjudicate claims by following departmental policies, operating memos, and corporate guidelines Resolve claims and related issues in compliance with policy provisions Compare claims applications and provider statements with policy files and other records to ensure completeness and validity Process payments for approved claims Maintain department quality standards and turnaround processing time Northwest Administrators, Inc. · Posted Nov 7, 2026
Assist in the operations of the Health and Welfare Claims Department focusing on member disputes and appeals.
Seattle, Washington, United States Mountlake Terrace, Washington, United States Federal Way, Washington, United States Hourly rate range of $30.70 - $41.54 per hour (dependent on experience & qualifications)
Review and process member and provider appeals, ensuring accuracy and adherence to policies Analyze claims, benefits, contracts and regulations to make informed appeal decisions Collaborate with internal teams to prepare and present appeal cases for resolution Clearly communicate appeal outcomes to members, providers and representatives Northwest Administrators, Inc. · Posted Nov 7, 2026
Assist in the operations of the Health and Welfare Claims Department focusing on member disputes and appeals.
Seattle, Washington, United States Mountlake Terrace, Washington, United States Federal Way, Washington, United States Hourly rate range of $30.70 - $41.54 per hour (dependent on experience & qualifications)
Review and process member and provider appeals, ensuring accuracy and adherence to policies Analyze claims, benefits, contracts and regulations to make informed appeal decisions Collaborate with internal teams to prepare and present appeal cases for resolution Clearly communicate appeal outcomes to members, providers and representatives Competitive Pay Paid Time Off Tuition Reimbursement
Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Life Insurance Short and long-term disability
Determine whether claims should be approved, denied, pended, suspended, or returned for additional information.
Process professional and facility claims in accordance with benefit plans and medical policies.
Verify claim accuracy, coding, billing standards, and completeness of documentation.
Investigate and resolve pending claims within established turnaround times. Nice to have: QNXT Claims Workflow Nice to have: ACA experience Nice to have: Medicaid experience Nice to have: medical coding Nice to have: claims repricing Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Life Insurance (Voluntary Life & AD&D) Short and long-term disability
Critical Illness, Accident, and Hospital
401(k) Retirement Plan
Life Insurance (Voluntary Life & AD&D)
Short and long-term disability
Provide guidance and support to members and providers on appeal procedures Bachelor’s degree or combination of relevant education and experience Medical, dental (w/orthodontia), vision, Rx benefits, disability & life insurance Optional benefits: health flex spending, dependent care assistance & pet insurance Generous 401(k) plan with company base contribution & match Paid Vacation (10 days), Sick Leave (10 days) and Holidays (10 days) Work-life balance
Provide guidance and support to members and providers on appeal procedures Bachelor’s degree or a combination of relevant education and experience Medical, dental (w/orthodontia), vision, Rx benefits Disability & life insurance Health flex spending Dependent care assistance Pet insurance
Revenue Cycle Specialist II HybridUniversity Hospitals · Shaker Heights, US
Medical Claims ExaminerTEKsystems · Fairfield, US+1 more
Appeals Specialist (Medical Claims)Northwest Administrators, Inc. · Seattle, US+2 more