Medical Claims Processor Job Description Template

The Medical Claims Processor is a vital role in the healthcare industry. They are responsible for accurately processing insurance claims and ensuring timely reimbursement for healthcare professionals and institutions. This job requires excellent organizational skills, attention to detail, and knowledge of medical billing codes and regulations. If you have a passion for helping others and enjoy working in a fast-paced environment, then this could be the job for you. In this job description template, you will find the necessary qualifications, responsibilities, and qualifications needed to excel in this role.

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A medical claims processor is responsible for analyzing, processing, and resolving medical claims for insurance companies and healthcare providers. This position requires strong attention to detail, excellent communication skills, and the ability to work effectively in a team environment.


  • Analyze medical claims for accuracy and completeness
  • Verify insurance coverage and eligibility
  • Investigate and resolve claim discrepancies
  • Communicate with healthcare providers and insurance companies to obtain missing information
  • Process medical claims within established timelines
  • Maintain accurate records of processed claims
  • Adhere to HIPAA regulations and other healthcare industry standards


Education and Experience

  • Bachelor’s degree in healthcare administration or related field preferred
  • Minimum two years of experience in medical claims processing
  • Knowledge of medical terminology, CPT and ICD-10 coding, and insurance billing procedures


  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
  • Attention to detail and accuracy
  • Ability to work independently and in a team environment
  • Proficient in Microsoft Office and medical claims processing software


  • Certified Professional Coder (CPC) or Certified Medical Coder (CMC) preferred
  • Certified Healthcare Financial Professional (CHFP) a plus


As the healthcare industry continues to grow, so does the demand for professionals skilled in medical claims processing. Whether you are a hospital, clinic, insurance company or a third party billing service provider, you may be looking to hire professionals to process medical claims. To help you reach the right candidate, creating an effective medical claims processor job posting is a must.

Job title and summary:

The first thing you need to decide is the job title. You want a title that is both accurate and attractive. A title such as Medical Claims Processor or Medical Claims Specialist is often used in the industry. In the summary of the job posting, provide a brief overview of the role and its responsibilities.

  • Job Title: Medical Claims Processor/Specialist
  • Job Summary: We are seeking a highly efficient and detail-oriented individual to join our team as a Medical Claims Processor/Specialist. The successful candidate will be responsible for ensuring timely and accurate processing of medical claims while adhering to industry standards and regulations.
  • Responsibilities:

    Outline the primary responsibilities of the job. Use bullet points for easy readability.

  • Analyze documentary evidence of medical procedures in order to prepare claim reimbursement evidence packages.
  • Verify the accuracy of all medical billing codes and invoice amounts.
  • Process claims in compliance with industry regulations and insurance company policies.
  • Follow-up on outstanding claims and delinquent accounts.
  • Provide excellent customer service to patients and insurance companies regarding claims inquiries.
  • Qualifications:

    List the required qualifications and experience for the job.

  • High school diploma or GED equivalent.
  • Minimum of 2-3 years of experience in medical claims processing role.
  • Proficiency in medical terminology, ICD and CPT coding.
  • Familiarity with federal and state regulatory requirements for medical billing and coding.
  • Excellent analytical and problem-solving skills.
  • Strong communication and interpersonal skills.
  • Ability to work independently and as part of a team.
  • Application process:

    Provide clear instructions on how to apply for the job. Explain if a cover letter or resume are required and if there are specific documents to be submitted. Also, provide information about the deadline for application and when candidates can expect to hear from the employer.

  • To apply for the Medical Claims Processor/Specialist position, please submit your updated resume and cover letter to the email address provided.
  • The deadline for applications is ___________.
  • Only qualified candidates will be contacted for an interview.
  • Conclusion:

    A well-written medical claims processor job posting will attract qualified candidates to apply for the job. Make sure to use clear and concise language to convey the job responsibilities and qualifications required. Good luck with your hiring process!

    Frequently Asked Questions: Creating Medical Claims Processor Job Posting

    Employers in the healthcare industry require a Medical Claims Processor to ensure claims are correctly processed and patients receive appropriate reimbursements. Creating a job posting to fill this role requires careful consideration to attract the best candidates. Here are some frequently asked questions to assist in creating a Medical Claims Processor job posting:

    1. What should be included in a Medical Claims Processor job posting?

    A strong Medical Claims Processor job posting should include the following:

    • Job title and Summary
    • Job responsibilities: including processing, analyzing and reconciling medical claims.
    • Qualifications: Educational requirements, certificates, and skills required.
    • Working hours: Specify hours of work and flexible times.
    • Remuneration: payment and benefits offered
    • Company and Culture: company overview and work environment
    • Hiring process, including application guidelines and interview process.

    2. What qualifications are necessary for a Medical Claims Processor?

    A Medical Claims Processor should have the following qualifications and skills:

    • A high school diploma or its equivalent is essential. A degree in Business Administration, Healthcare or related field also can be useful.
    • Experience in Medical Billing and Coding is required.
    • Attention to detail and high level of accuracy.
    • Excellent communication and customer service skills
    • Strong analytical and problem-solving skills
    • Ability to work under minimal supervision

    3. What should I highlight in the job responsibilities section?

    The job responsibilities section should include a list of key duties involved in the position, which might include:

    • Accurately process insurance claims
    • Review denials and make appropriate revisions
    • Appeal claim denials
    • Analyze insurance claims trends
    • Gather and interpret payer's insurance policies.
    • Verify patient’s medical records with insurance.
    • Liaising with insurance companies and healthcare providers.
    • Maintain accurate records of all claims processed.

    4. What should I emphasise about company culture?

    A job posting that provides information about the potential employer's culture and work environment is an essential aspect that job seekers consider when applying for a job. Here are a few things you could highlight:

    • Values: Detail company principles, culture and beliefs.
    • Culture: Share what its like to work with other team members, management style and inclusive diversity policies.

    5. How should the hiring process be announced?

    Provide clear instructions on how to apply and expected timelines. The process should include online application submission, potential phone or email screening, scheduling interview processes/nature of interviews.

    Creating a Medical Claims Processor job posting requires careful drafting to identify the right candidate. With an effective job posting, potential candidates can have a clear understanding of the role and responsibilities, and the employer can attract the best candidates with the necessary qualifications and skills.

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