Claims Research Jobs
What is a Claims Researcher?
A Claims Research Specialist investigates and resolves complex issues related to healthcare insurance claims. This role ensures accurate and timely reimbursement by analyzing discrepancies, verifying documentation, and coordinating with providers, payers and internal departments.
What does a Claims Research Specialist do?
Key job responsibilities for a claims researcher may include:
Reviews claim files and reports on the performance levels of services provided by insurance carriers, using a thorough understanding of insurance adjusting practices
Ensures all claims are handled properly by maintaining a claims management diary system
Resolves any questions the client or patient may have in regards to the claims process, claims status and settlements
Works to ensure that claim submissions that require research or special handling are processed efficiently
Reconciles claim reserves on a weekly basis to ensure proper tracking and reporting
How to Work as a Claims Researcher
The ideal Claims Research Specialist is a detail-oriented and analytical professional with a strong understanding of healthcare billing, insurance policies and medical coding. They excel at investigating claim discrepancies, resolving denials, and ensuring accurate reimbursement through effective communication with payers and providers and bring a proactive approach to problem-solving and thrive in fast-paced environments such as hospitals, insurance companies or medical billing firms.
Skills and qualifications needed:
Generally, some college experience in a related field of study such as business or marketing is preferred
A valid Insurance Adjuster’s license is required
At least a year of insurance claims adjusting experience is required for most positions
Impeccable customer service, organizational, and analytical skills are a must
Possession of excellent written and verbal communication skills needed
A strong working knowledge of Microsoft Word and Excel is required
Where Do Claims Research Specialists Work?
Claims researchers are found in a variety of healthcare environments, including but not limited to:
Health insurance companies
Hospitals and health systems
Medical billing and revenue cycle management firms
Outpatient clinics and specialty practices
Government health agencies
Remote or hybrid healthcare operations roles
Your Career, Your Way
At HealthCare Support, we don’t just help you find a job, we help you build a career that reflects your goals, values and potential. With a dedicated recruiting specialist by your side, our personalized hiring process is designed to uncover opportunities that truly fit. If you're ready to make a meaningful impact in healthcare and want a partner who’s invested in your success, HealthCare Support is where your journey begins.