Claims Examiner (Commercial, Medicaid & Medicare)

Claims Examiner | Direct Hire

Location: Pittsburgh, PA 15233 – (North Side)
(Hybrid) - The role includes a mix of on-site and remote workdays. Specific schedules may vary by team or role.
Schedule: Monday – Friday, daylight schedule
Employment Type: Full-Time, Regular (Permanent)
Starting Rate: $19.80 – $22.45 per hour (Initial pay is targeted up to the 25th percentile of the full range)

Why Apply Through Us?

Partner with a dedicated recruitment team that serves as your personal advocate. We provide concierge-level support through every step of the employment lifecycle—from resume review to interview prep—at no cost to you.

This is a Direct Hire opportunity. You will be a permanent, full-time employee of a leading healthcare organization from day one; this is not a temporary or contract assignment.

Compensation & Career Growth

Starting Range: $19.80 – $22.45 per hour.
Long-Term Earning Potential: This position offers a clear path for financial growth. Through continuous learning, advanced education, and consistent high performance over time, employees have the opportunity to earn up to $30.40 per hour as they progress within the role.
Tuition Reimbursement: Take advantage of exceptional programs to support your continued education and help you reach your long-term salary goals.

Premier Benefits

Work-Life Balance: Generous Paid Time Off (PTO), paid holidays
Financial Security: Retirement plans with an employer match.
Comprehensive Coverage: Full medical, dental, and vision insurance, plus life and disability coverage.

The Role

As a Claims Examiner, you will join the Operations department to manage the adjudication of standard to moderate healthcare claims.

Process claims and Coordination of Benefits (COB) accurately and efficiently.
Resolve outstanding holds and process batch edit errors.
Maintain strict confidentiality of insured/employee information.
Collaborate with team members to ensure client satisfaction and meet production standards.

Mandatory Requirements:

Education: High school diploma or equivalent
Knowledge: Proficiency in Medical Terminology, ICD-9/10, and CPT coding
Experience: Minimum 1 year of health insurance claims processing experience
Systems: Comfort with MS Office, QWERTY keyboarding, and knowledge of Medicaid/Medicare products.
Aptitude: Strong interpersonal skills and the ability to prioritize tasks in a fast-paced environment.