Claims Operations Specialist Jobs
Claims Operations Specialist jobs are open across insurance, healthcare, financial services, and third-party administrators, from entry-level to senior and team lead, with specializations in medical claims, property and casualty, and workers' compensation. See the openings below and apply to the ones that match your experience.
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Start Health is an independent, individual health coverage program powered by MotivHealth. Our plans are HSA-eligible and built on a cash-pay, reimbursement-based model designed to make healthcare more transparent, affordable, and flexible. While Start Health aligns with MotivHealth’s broader mission to make healthcare smarter and simpler, it operates under its own brand, systems, and operational structure.
The Claims Operations Specialist & Provider Coordination role plays a key part in supporting Start Health’s claims operations and provider engagement efforts. This position focuses on ensuring claims are processed accurately and efficiently, while also serving as a primary point of contact for medical providers when additional documentation, clarification, or coordination is required.
In addition to supporting the end-to-end claims process, this role contributes to strengthening Start Health’s provider network by building relationships with high-value providers and helping align them with our reimbursement model and documentation standards. The role requires strong attention to detail, proactive follow-through, and comfort communicating with medical offices.
This position reports to the Claims Processing Manager and is designed to scale with the company as Start Health continues to grow.
What you’ll do in this role:
- Support the review and processing of member claims to ensure accuracy and completeness
- Communicate with providers to obtain claim documentation and help strengthen ongoing provider relationships
- Maintain clear, accurate claim notes and supporting documentation in internal systems
- Assist with claim status updates and internal coordination to support timely resolution
- Escalate complex or non-standard claim issues as appropriate
- Assist and support cross-team initiatives
- Any other duties and responsibilities assigned by management
Required:
Must have High School Diploma or GED
What we offer:
- 5% bonus based on company profitability
- Affordable health, vision, and dental insurance for you and your family
- Company contributes up to $2,300 to Health Savings Account annually
- Wellness program that contributes additional money towards your HSA
- Automatic 3% contribution into retirement plan
- Career development and growth opportunities
- 15 days of PTO & 10 paid holidays per year
Claims Operations Specialist Jobs by Experience Level
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Find JobsClaims Operations Specialist Job Market
Who's Hiring
Top Industries Hiring
- Insurance
What Employers Look For
The qualifications that appear most often in claims operations specialist jobs.
- Two or more years of experience processing medical, P&C, or workers' compensation claims
- Proficiency in claims management systems such as Facets, TriZetto, or Guidewire
- Knowledge of ICD-10 coding, CPT codes, and EOB interpretation for medical claims roles
- Strong understanding of claims adjudication workflows, denial management, and appeals processes
- Associate or bachelor's degree in business, healthcare administration, or a related field
- Familiarity with state and federal claims regulations, compliance requirements, and audit procedures
Tips for Your Claims Operations Specialist Job Search
Tailor your resume to claim types
Hiring managers scan for the specific claim line you've processed, whether medical, P&C, or workers' comp. Name your claim type, the volume you handled per day, and any adjudication software you used so your resume passes the first cut.
Highlight denial management and appeals experience
Many postings specifically call out denial resolution and appeals workflow knowledge. If you've investigated underpayments, written appeal letters, or tracked payer trends, put those tasks front and center rather than burying them under general operations duties.
Earn a claims certification before applying
A designation like CPIC or an associate-level certification from the American Institute for Chartered Property Casualty Underwriters signals baseline competency to employers who screen credentials before interviews, especially at carriers and large TPAs.
Apply early to roles that fit
Migrate Mate lists claims operations specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare audit and compliance examples for interviews
Interviewers frequently ask how you've caught billing errors or handled regulatory audits. Walk in with two or three concrete examples that describe the error type, the corrective action you took, and the outcome, using numbers where you can recall them.
Negotiate by citing your accuracy and throughput metrics
Generic salary negotiation falls flat in this field. Reference your documented claims accuracy rate and daily or weekly processing volume, since those metrics are exactly what supervisors track and they give you a verifiable basis for a higher offer.
Claims Operations Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most claims operations specialists?
The companies hiring the most claims operations specialists right now include USAA, MedPro, and Berkshire Hathaway GUARD Insurance Companies, with the largest share of openings in Texas, California, and Pennsylvania, based on current listings on Migrate Mate as of November 2026. Insurance carriers, third-party administrators, and large health systems consistently post the highest volume of these roles.
How many claims operations specialist jobs are remote?
About 88% of claims operations specialist openings are fully remote or hybrid as of November 2026, reflecting sustained demand for experienced processors who can work independently. Roles focused on medical billing review, denial management, and document auditing tend to be the most remote-friendly, while positions requiring direct adjuster collaboration are more likely to be on-site or hybrid.
How do you become a claims operations specialist?
Start by earning a degree or certificate in business, healthcare administration, or insurance, then gain hands-on experience in a claims processing, billing, or customer service role. Learning a major claims management platform strengthens your candidacy significantly. Pursuing an industry certification from a recognized professional body, then targeting entry-level claims analyst or examiner roles, is the most direct path into the specialty.
Can you get a claims operations specialist job with little experience?
Yes, many employers hire candidates with limited direct claims experience if they can demonstrate transferable skills. Administrative, data entry, billing, or customer service backgrounds translate well. Completing a claims-specific training course, learning relevant coding systems like ICD-10 and CPT, and targeting TPA or staffing firms that offer structured onboarding programs improves your odds considerably at the entry level.
What does the claims operations specialist interview process look like?
Most employers run two to three rounds starting with a phone screen focused on your claims background and system experience. A second round typically involves scenario-based questions about how you handle denials, billing discrepancies, or compliance issues. Some employers add a skills assessment that tests your ability to interpret an EOB or walk through an adjudication decision before extending an offer.
Where can I find and apply to claims operations specialist jobs?
You can find and apply to claims operations specialist jobs on Migrate Mate, which lists current openings from across the United States. Search the listings to find roles that match your claims background, preferred location, and claim type, then apply directly to each listing that fits.
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