Medical Claims Specialist Jobs
Medical claims specialist jobs are open across healthcare systems, insurance carriers, third-party administrators, and physician groups, at every level from entry-level to senior and lead, with specializations in denial management, medical coding support, and payer contract review. See the openings below and apply to the ones that match your experience.
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Join a Growing Healthcare Company
BioHorizon Medical is a specialized healthcare company dedicated exclusively to the treatment of lymphedema through advanced compression garment therapy. We work closely with physicians, hospitals, health systems, and insurance providers throughout California and Nevada to deliver medically necessary products to patients suffering from chronic circulatory disorders.
Unlike traditional medical equipment companies, BioHorizon operates through an innovative manufacturer-direct fulfillment model supported by sophisticated claims administration, technology, and operational excellence.
We are a growing organization that values integrity, accountability, innovation, and continuous improvement. Our culture is collaborative, entrepreneurial, and hands-on. We believe in hiring talented people who enjoy solving problems, taking ownership of their work, and growing professionally.
If you are an experienced medical claims professional looking for a position where your knowledge and judgment matter, this role offers the opportunity to become an integral member of a specialized healthcare organization and take ownership of claims from billing through collection.
Position Summary
BioHorizon Medical is seeking an experienced Claims Representative with a proven track record in medical claims administration involving Durable Medical Equipment (DME), Home Medical Equipment (HME), or a closely related healthcare environment.
The position requires proficiency in full-cycle medical claims billing and collections, including claim preparation and submission, documentation review, payment follow-up, denial resolution, and collection of outstanding insurance balances.
The successful candidate will have a strong working knowledge of Medicare and commercial insurance requirements and understand the relationship between prescriptions, medical documentation, insurance coverage, claim submission, payment, and collections.
This is a hands-on position requiring accuracy, organization, persistence, critical thinking, and the ability to independently manage a claims workload from initial billing through final resolution.
Primary Responsibilities
- Manage assigned medical claims through the complete billing and collection cycle.
- Prepare and submit accurate claims to Medicare and commercial insurance carriers.
- Monitor submitted claims and proactively follow up on unpaid or delayed claims.
- Research and resolve claim denials, rejections, underpayments, and documentation issues.
- Prepare corrected claims, reconsiderations, and appeals when appropriate.
- Communicate with insurance carriers regarding claim status, coverage, documentation, and payment issues.
- Maintain accurate and timely documentation of claim activity within the company’s healthcare ERP system.
- Monitor outstanding receivables associated with assigned claims and pursue resolution through payment or appropriate final disposition.
- Maintain compliance with Medicare requirements, payer policies, company procedures, HIPAA, and applicable accreditation standards.
- Identify recurring billing or documentation issues and contribute to process improvements that increase claim accuracy and collection efficiency.
- Participate in special projects and operational initiatives as the company continues to grow.
Systems Used
The successful candidate will work with several integrated business systems, including:
- TIMS ERP medical claims management platform
- Microsoft Office
- Microsoft Outlook
- Microsoft Excel
- Microsoft 365 applications
Experience with TIMS is preferred but not required. Experience with comparable DME/HME billing or healthcare claims management systems is highly relevant.
Qualifications
- Minimum 5 years of recent experience in medical claims administration, billing, and/or collections.
- Demonstrated experience with DME/HME claims or a closely related healthcare billing environment.
- Strong working knowledge of Medicare medical billing and collection requirements.
- Experience with commercial health insurance billing and collections.
- Demonstrated proficiency in full-cycle claims management from billing through payment and final resolution.
- Experience researching and resolving claim denials, rejections, and underpayments.
- Working knowledge of prescriptions, medical necessity documentation, patient medical records, and healthcare payer documentation requirements.
- Understanding of HIPAA and the proper handling of protected health information.
- Strong computer skills and the ability to work efficiently within healthcare billing and data-management systems.
- Excellent written and verbal communication skills.
- Strong organizational and multi-tasking abilities in a fast-paced environment.
- Strong analytical and problem-solving skills.
- High degree of professionalism, integrity, accuracy, and attention to detail.
- Ability to independently prioritize and manage a substantial claims workload while meeting deadlines.
Preferred Qualifications
- Direct experience with Medicare DMEPOS claims.
- Experience with compression garments, orthotics/prosthetics, or other specialized medical products.
- Experience using TIMS or a comparable DME/HME ERP or billing platform.
- Experience working with physician prescriptions, medical records, and supporting documentation for insurance claims.
- Experience working in a small to mid-sized healthcare organization where versatility, initiative, and personal accountability are essential.
Compensation & Benefits
- Hourly compensation: $28.00 – $31.00, commensurate with experience
- 401(k)
- 401(k) employer matching
- Health insurance stipend
- Paid Personal Time Off (PTO)
- Paid holidays
- Professional growth and advancement opportunities
Why BioHorizon?
Claims administration is a critical function at BioHorizon. Our ability to provide medically necessary products to patients depends upon accurate documentation, compliant billing, effective payer communication, and disciplined follow-through.
This position offers an experienced claims professional the opportunity to take meaningful ownership of that process within a specialized healthcare company. You will work with a knowledgeable team, handle a broad range of payer and claims issues, and have the opportunity to contribute directly to improvements in our claims operations.
If you are an experienced medical claims professional who enjoys solving difficult claims, taking ownership of your work, and seeing issues through to resolution, we encourage you to apply.
Schedule & Work Location
This is a full-time, onsite position based at our corporate office at 3625 Del Amo Boulevard, Suite 310, Torrance, CA 90503. Standard hours are Monday through Friday during regular business hours. This is not a remote or hybrid role.
Pre-Employment Requirements
Employment is contingent upon the successful completion of a background check in accordance with applicable federal and California law.
How to Apply
Qualified candidates are encouraged to apply directly through Indeed. Please submit your resume describing your relevant DME/HME, Medicare, medical billing, and claims collection experience.
Equal Opportunity Employer
BioHorizon Medical, Inc. is an Equal Opportunity Employer. We are committed to providing a workplace free of discrimination and harassment. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran
Job Type: Full-time
Pay: $29.00 - $32.00 per hour
Benefits:
- 401(k)
- 401(k) 4% Match
- Paid time off
Work Location: In person
Medical Claims Specialist Jobs by Experience Level
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Find JobsMedical Claims Specialist Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in medical claims specialist jobs.
- One to three years of medical claims processing or billing experience
- Proficiency with practice management or claims adjudication software such as Epic or Waystar
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Familiarity with Medicare, Medicaid, and commercial payer billing guidelines
- Experience working denied or rejected claims through resolution
- High school diploma or equivalent required, with an associate degree or coding certification preferred
Tips for Your Medical Claims Specialist Job Search
Tailor your resume to payer-specific language
Highlight the specific payers you've worked with, such as Medicare, Medicaid, or commercial carriers, and the claim types you've processed. Recruiters scan for payer familiarity fast, and generic billing experience won't stand out in a stack of specialized resumes.
List your credentials front and center
If you hold a Certified Professional Coder, Certified Billing and Coding Specialist, or similar credential, put it directly under your name. Many job postings filter candidates by certification, and burying it in the body of your resume costs you interviews.
Target openings by claim volume and system
Filter job listings by the practice management or claims platform named in the description. Matching your hands-on experience with a specific system, whether Epic, Waystar, or similar, signals you can contribute from day one and shortens the employer's training window significantly.
Apply early to roles that fit
Migrate Mate lists medical claims specialist openings from across the United States in one place, so you can find roles that match and apply directly to each listing.
Prepare for denial scenario questions in interviews
Interviewers frequently walk through a hypothetical denial case and ask how you'd work it. Practice explaining your process for identifying the root cause, correcting the claim, and resubmitting within payer timelines. Vague answers here cost offers.
Negotiate using your clean claim rate
If you can speak to your first-pass resolution rate or average days-to-payment from prior roles, use those figures in salary conversations. Quantifying your accuracy and speed gives you a concrete basis for a higher offer that hiring managers can defend internally.
Medical Claims Specialist Jobs: Frequently Asked Questions
Which companies are hiring the most medical claims specialists?
Sedgwick, CorVel Corporation, and Liberty Mutual Insurance are hiring the most medical claims specialists right now, with openings concentrated in California, Texas, and Colorado, based on current listings on Migrate Mate as of November 2026. Volume tends to be highest at large health systems, national insurance carriers, and revenue cycle outsourcing firms.
How many medical claims specialist jobs are remote?
About 63% of medical claims specialist openings are fully remote or hybrid as of November 2026, reflecting how thoroughly digital the claims workflow has become. Remote roles are most concentrated in denial management, payer follow-up, and high-volume institutional billing, where work is system-based and doesn't require on-site patient interaction.
How do you become a medical claims specialist?
Start by completing a medical billing and coding program at a community college or accredited vocational school, which typically covers claim submission, payer guidelines, and coding fundamentals. Earning a credential such as the Certified Billing and Coding Specialist strengthens your application. Entry-level roles in patient financial services or front-desk billing can also provide a pathway into dedicated claims work.
Can you get a medical claims specialist job with little or no experience?
Yes, employers do hire candidates with limited direct experience, especially when you hold a relevant certification or have completed a billing and coding program. Emphasize transferable skills such as data entry accuracy, attention to detail, and customer-facing experience in healthcare settings. Many health systems also post entry-level claims processor roles that serve as a formal starting point before promoting into specialist positions.
What does the medical claims specialist interview process look like?
Most processes include an initial phone screen with a recruiter focused on your claims background and system experience, followed by one or two rounds with the revenue cycle or billing manager. Expect scenario-based questions on how you handle denials, work aging accounts receivable, and prioritize a high-volume queue. Some employers include a short skills assessment covering coding or payer guideline knowledge before extending an offer.
Where can I find and apply to medical claims specialist jobs?
You can find and apply to medical claims specialist jobs on Migrate Mate, which lists current openings from across the United States. Search for roles that match your payer experience, claim type, or preferred work setting, and apply directly to each listing that fits your background.
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