Free claims processor job description templates: general insurance, medical, dental, entry-level, and senior, with FLSA, HIPAA, and BLS salary guidance.
6 free templates by setting and level: general insurance, medical, dental, entry-level, senior, and small office, with the FLSA, HIPAA, and salary guidance the generic templates skip. Download as DOCX.
A claims processor reviews, verifies, and processes insurance claims, keeping them accurate and moving on time. It is a detail-focused, hourly role hired not only by big carriers but by a large number of small offices: independent insurance agencies, medical and dental practices, and billing companies, usually by an owner or office manager with no HR department, and often under a title like insurance coordinator.
At FirstHR, we build for those small offices making the hire. The six templates below are split by setting and level, general insurance, medical, dental, entry-level, senior, and a small-office first hire, each with the FLSA classification, HIPAA, and salary guidance the generic templates skip. For the fundamentals behind any posting, the guide to writing a job description is a useful companion.
TL;DR
A claims processor reviews, verifies, and processes insurance claims under set guidelines. It is a clerical, non-exempt, hourly role with a federal median near $48,450 a year (about $23 an hour), and it is distinct from a higher-paid claims adjuster ($76,790 median) who decides claims. In medical and dental settings, HIPAA applies. Download six templates as DOCX, by setting and level, with the compliance built in.
What Is a Claims Processor?
A claims processor handles the clerical side of insurance claims: reviewing and verifying claims forms, entering and updating claim data, communicating with policyholders and providers, applying policy terms under established guidelines, and keeping records accurate. Complex or questionable claims are escalated to an adjuster or examiner who evaluates and decides them.
The closest federal occupation is insurance claims and policy processing clerks (SOC 43-9041), which the U.S. Department of Labor lists with claims processor among its sample job titles. The role spans insurance, medical, and dental settings, which is why the templates on this page are split by setting and level rather than offering one generic block.
Claims Processor vs Adjuster vs Examiner
These titles are constantly confused, and the difference drives pay, classification, and licensing. A processor handles and routes claims; an adjuster and examiner evaluate and decide them, in a separate, higher-paid occupation that is often licensed.
Role
What they do
Federal median
Notes
Claims processor
Review, verify, and process claims clerically
$48,450
Non-exempt, hourly; HS diploma
Senior claims processor
Complex claims, escalations, mentoring
Higher end of band
Still non-exempt, clerical
Claims examiner
Review claims and adjusters' work
$76,790 (with adjusters)
Higher occupation
Claims adjuster
Investigate, evaluate, and decide claims
$76,790
Often state-licensed
The pay gap reflects the work: processing claims versus deciding them. Title the role for what you actually need, and for the higher-level roles the claims adjuster occupation carries its own licensing and pay considerations worth a separate posting.
Claims Processor Duties and Responsibilities
Claims processor duties cluster into four areas: review and verify, process and record, communicate, and resolve and escalate. A strong job description picks the responsibilities from each area that match your setting and systems rather than listing every possible task.
Review and verify
Check claims forms for completeness
Verify policyholder and coverage details
Confirm coding or documentation accuracy
Process and record
Enter and update claim data
Apply policy terms and guidelines
Maintain accurate, timely records
Communicate
Contact policyholders, agents, and payers
Request missing documentation
Explain status and resolve simple issues
Resolve and escalate
Work denials and resubmissions
Resolve routine discrepancies
Escalate complex claims to an adjuster
The emphasis shifts by setting: medical and dental roles add coding and HIPAA, while general insurance leans on policy verification. For a structured way to scope the role, the guide to defining job responsibilities walks through the process.
Which Template Should You Use?
Pick the template by setting and level. The core structure is shared, but each version emphasizes the duties, systems, and compliance that fit a specific kind of claims processor role. Use this guide to choose the closest fit, then adjust.
General Insurance
Agencies, carriers, TPAs
The base version: review, verify, and process insurance claims, communicate with policyholders, and keep records. The starting point to adapt.
Medical Claims Processor
Practices, billing companies
The healthcare version: verify eligibility, check CPT and ICD-10 coding, submit to payers, post payments, and work denials, with HIPAA.
Dental / Insurance Coordinator
Dental practices
The dental version: verify benefits, submit claims with CDT codes, work denials, and explain coverage to patients. Often titled insurance coordinator.
Entry-Level
First job, with training
For a first hire with no experience: completeness checks, data entry, and document handling under guidance, with on-the-job training.
Senior Claims Processor
Experienced, mentoring
For complex, high-volume claims: handle escalations, support quality, and train newer processors. Still non-exempt and hourly.
Small Office / First Hire
Small agency or practice
The version no competitor offers: a wear-several-hats first claims hire who owns the work directly with the owner of a small office.
Match the Template to the Setting
An insurance agency, carrier, or TPA: General Insurance. A practice or healthcare billing company: Medical. A dental office: Dental / Insurance Coordinator. A first hire with no experience: Entry-Level. An experienced processor who mentors: Senior. A small office's first or only claims hire: Small Office. When in doubt, the General Insurance version is the baseline to adapt.
6 Claims Processor Job Description Templates
Download all six as a single Word document or copy individual templates. Each follows the same structure: company summary, job summary, key responsibilities, qualifications, a compensation section, an FLSA classification note, and how to apply, with an EEO statement. Fill in the brackets and post.
Download All 6 Job Description Templates
General insurance, medical, dental, entry-level, senior, and small office. All in one DOCX.
Template 1: Claims Processor (General Insurance)
The base version: review, verify, and process insurance claims, communicate with policyholders, and keep records. The starting point to adapt to your office.
For complex, high-volume claims: handle escalations, support quality, and train newer processors. Still non-exempt and hourly.
Senior Claims Processor Job Description
SENIOR CLAIMS PROCESSOR JOB DESCRIPTION
Company: __ ([City, State])
Reports to: __ (Claims Supervisor / Manager)
Employment type: Full-time
FLSA status: Non-exempt (hourly) [confirm by duties]
Compensation: $_ per hour or $_____ per year
JOB SUMMARY
[Company Name] is hiring a Senior Claims Processor to handle higher-volume and more
complex claims, support quality, and help train newer processors. You will process
claims accurately, resolve escalations, and serve as a go-to resource on guidelines
and systems.
KEY RESPONSIBILITIES
•Process complex and high-volume claims accurately
•Resolve escalated discrepancies and difficult cases
•Review work and support quality and accuracy standards
•Train and mentor newer claims processors
•Maintain expert knowledge of policies and procedures
•Liaise with adjusters, examiners, and other departments
•Identify and suggest process improvements
•Maintain records and meet productivity targets
REQUIRED QUALIFICATIONS
•High school diploma or equivalent; associate's a plus
•[3-5+] years of claims processing experience
•Strong knowledge of claims systems and guidelines
•Accuracy, productivity, and problem-solving skills
•Ability to mentor and support a team
•Clear communication across departments
COMPENSATION
A senior processor commands the higher end of the range, often the mid twenties to
low thirties per hour. State a pay range and include it where required.
Pay range: $_ to $_ per hour
FLSA CLASSIFICATION NOTE
Classify by the real duties; a senior processor doing primarily clerical work
remains non-exempt and owed overtime. This is general information, not legal advice.
HOW TO APPLY
To apply, send your resume to __ by _.
[Company Name] is an equal opportunity employer.
Template 6: Claims Processor (Small Office / First Hire)
The version no competitor offers: a wear-several-hats first claims hire who owns the work directly with the owner of a small office.
Claims Processor Job Description (Small Office / First Hire)
CLAIMS PROCESSOR JOB DESCRIPTION (SMALL OFFICE / FIRST HIRE)
Company: __ (small agency / practice / billing office)
Location: __
Reports to: [Owner / Office Manager]
Employment type: [ ] Full-time [ ] Part-time
FLSA status: Non-exempt (hourly)
Compensation: $_ per hour
ABOUT US
We are a small [insurance agency / medical or dental practice / billing office]
hiring our first or only claims processor. This is a hands-on, wear-several-hats
role for someone who can own claims handling and work directly with the owner and
the team.
WHAT YOU WILL DO
•Own day-to-day claims review, entry, and follow-up
•Verify information and resolve simple discrepancies
•Communicate with policyholders, patients, agents, or payers
•Submit claims and track them to payment
•Work denials and keep records accurate
•Help with front-office or billing tasks as needed
•Protect confidential information [and follow HIPAA if healthcare]
WHAT WE ARE LOOKING FOR
•High school diploma or equivalent
•[1-2] years in claims, insurance, billing, or office work
•Reliable, organized, and comfortable owning the work
•Accurate data entry and good communication
•Comfortable on a small team wearing several hats
COMPENSATION (read before posting)
A versatile first hire often commands the higher end of the local range. Claims
processor pay centers near $23 an hour (federal median). State a pay range and
include it where required.
Pay range: $_ to $_ per hour
FLSA CLASSIFICATION NOTE
This is a non-exempt, hourly role owed overtime. Routine clerical claims work does
not meet a white-collar exemption. This is general information, not legal advice.
HOW TO APPLY
To apply, send your resume to __ by _.
[Company Name] is an equal opportunity employer.
Claims Processor Salary
A claims processor is an hourly role with pay centered just above $23 an hour, varying by setting, region, and experience. Anchor your range to federal data, then adjust for level and market.
Median About $48,450 (BLS)
Insurance claims and policy processing clerks, the closest federal occupation, have a median wage of $48,450 a year, about $23.29 an hour, per U.S. Department of Labor data for May 2024 (O*NET, U.S. DOL). That is well below the $76,790 median for claims adjusters, examiners, and investigators, a separate and higher occupation. Employment in the processor role is projected to decline slightly through 2034 as processing automates.
Entry-level processors start in the high teens to low twenties per hour, and senior processors reach the mid twenties to low thirties. Pay-transparency laws in a growing number of states now require a salary range in the job posting, so set and publish a range that reflects your market. State a range and include it where your state requires it.
FLSA, HIPAA, and Career Path
Four things belong in or behind every claims processor posting, and they are the parts generic templates skip: the non-exempt classification, the processor-versus-adjuster distinction, HIPAA in healthcare settings, and the career path that helps you attract and keep a good hire.
FLSA: a claims processor is non-exempt and owed overtime
The single most overlooked point in hiring a claims processor is classification, and it is straightforward once you know the rule. A claims processor performs routine clerical work, reviewing, verifying, and entering claims under established guidelines, without the independent judgment on significant matters that the administrative exemption requires. The Department of Labor treats this kind of clerical work as non-exempt, which means the role is paid hourly and owed overtime at one and a half times the regular rate for hours over 40 in a week. A salary above the federal threshold of $684 per week does not by itself make the role exempt, because the duties test still has to be met, and routine claims processing does not meet it. Pay the role hourly, track hours, and pay overtime. None of the generic templates explain this. This is general information, not legal advice.
Processor is not adjuster: a costly title mix-up
Claims processor and claims adjuster are constantly confused, and the difference matters for pay, classification, and licensing. A claims processor is a clerical role that reviews, verifies, and processes claims under set guidelines, with a federal median near $48,000 a year. A claims adjuster, examiner, or investigator is a separate, higher occupation that evaluates claims and decides whether and how much to pay, with a federal median of $76,790, and adjusters are often required to hold a state license. Advertising a processor role with adjuster duties, or paying adjuster wages for processor work, creates mismatched expectations and budget problems. Decide which role you actually need, title it correctly, and set the pay and any licensing requirement to match. The comparison table on this page lays out the difference.
HIPAA applies to medical and dental claims work
A claims processor in a medical or dental setting handles protected health information all day, which brings the role under HIPAA. The practice or billing company must provide HIPAA privacy and security training, limit access to the minimum necessary, and have the processor sign a confidentiality acknowledgment. For a small practice, this is easy to overlook when the same person handles claims, the front desk, and patient calls, but the obligation is the same as at a large organization. Build HIPAA training and a signed confidentiality acknowledgment into onboarding before the new hire touches patient records, and note the HIPAA expectation in the posting so candidates understand the role. This is general information, not legal advice.
Career path: where the role goes next
Framing the career path helps a small employer attract and keep a good processor, and it sets honest expectations. The common ladder runs from claims processor to senior or lead processor, then to claims specialist, claims examiner, and ultimately claims adjuster, with pay rising at each step as the work shifts from clerical processing to evaluating and deciding claims. A processor who learns the business is well positioned to move up, and saying so in the posting and the first review signals that the role is a starting point, not a dead end. For a small office, this matters because it competes for talent against larger carriers, and a clear path plus a good first hire reduces the turnover that hits small teams hardest.
Non-Exempt Is Not Optional Here
A claims processor performs routine clerical work and does not meet the administrative exemption, so the role is non-exempt and owed overtime, even if paid a salary above $684 per week, because the duties test still governs. Paying a flat salary and ignoring overtime builds a wage-and-hour liability. Pay hourly, track hours, and pay overtime. This is general information, not legal advice.
A large carrier hires claims processors through an HR department. A small insurance agency, dental office, or billing company does not; the owner or office manager writes the posting, screens applicants, and onboards the hire, usually between everything else. Here is how to write the posting, and make the hire, for that reality.
Small offices hire this role too, often under a different title
Big carriers and national billing companies hire claims processors in volume, but a large share of the real hiring happens at small offices: independent insurance agencies, medical and dental practices, and small billing companies, many of them teams of five to thirty people where the owner or office manager does the hiring. One wrinkle is terminology: a small practice often advertises the same work as an insurance coordinator or billing coordinator rather than a claims processor. The templates that rank online are written generic, for a corporate recruiter, with no version for a small office. The fix is to match the posting to your setting and use the title your candidates actually search, which is why these templates split by general insurance, medical, dental, level, and the small-office first hire.
Classify the role correctly from the start, because overtime adds up
Because claims processing is routine clerical work, the role is non-exempt and owed overtime, and a small office that pays a flat salary and ignores overtime can build a real wage-and-hour liability without realizing it. The safe approach is to pay hourly, track hours honestly, and pay overtime for anything over 40 in a week, even for a salaried-looking senior processor whose duties are still clerical. A title or a salary above the threshold does not make the role exempt; the duties decide it, and routine claims work does not pass the test. Getting this right at the offer stage, with the classification stated in writing, is far cheaper than fixing it after a complaint or an audit.
Onboarding a claims hire is mostly paperwork and access, done right
Once someone accepts, a claims processor hire is ordinary new-hire setup with a couple of role-specific additions: the signed offer with the hourly classification, the I-9 and W-4 and state new hire reporting that every hire requires, claims-system and payer-portal access, and, in a medical or dental setting, HIPAA training and a signed confidentiality acknowledgment before the new hire touches patient records. For a small office without HR, the risk is not complexity, it is that these steps get done informally and inconsistently, so a missing I-9 or an undocumented HIPAA training surfaces later. Turning the sequence into a standard, repeatable onboarding checklist is what keeps a small office compliant without adding headcount.
From Hiring to Onboarding
The job description is step one. Once a candidate accepts, a claims processor hire is mostly standard new-hire paperwork plus system access and, in healthcare, HIPAA training, all of which is easy to do informally and inconsistently at a small office.
Send the offer
An offer letter that states the hourly, non-exempt classification and pay rate, signed before the first day.
Complete new-hire paperwork
The I-9 within three days, the W-4, and state new hire reporting, plus a confidentiality acknowledgment.
Train and provision access
Claims-system and payer-portal access, company guidelines, and HIPAA training where the setting is medical or dental.
Store the records
Keep the signed offer, I-9, tax forms, and training acknowledgments organized and easy to retrieve.
Once your offer is ready, the offer letter template handles the hire with the hourly classification stated, and an onboarding template gives the new processor a structured start.
The new hire paperwork guide covers the I-9, W-4, and state new hire reporting that every employee hire requires.
FirstHR connects the people side of the hire for a small office: e-signature for the offer letter and confidentiality acknowledgment, an AI onboarding wizard and task workflows that build a role-based checklist for system access and training, document management for the I-9, W-4, and signed forms, and training assignments for HIPAA and company guidelines, all at a flat monthly price that suits a small team without an HR department. FirstHR is an onboarding and HR platform, not a claims or billing system, so connect those separately. Applicant tracking is coming soon to FirstHR.
Key Takeaways
A claims processor reviews, verifies, and processes insurance claims under set guidelines across insurance, medical, and dental settings.
Use the template that matches the setting and level: general insurance, medical, dental, entry-level, senior, or small office.
The role is non-exempt and hourly, owed overtime; a salary above the threshold does not make routine clerical work exempt.
A processor is not an adjuster: the federal medians are about $48,450 versus $76,790, and adjusters are often licensed.
In medical and dental settings, HIPAA applies; train it and sign a confidentiality acknowledgment before access to records.
Small offices hire this role too, often titled insurance or billing coordinator; use the title candidates actually search.
Frequently Asked Questions
What does a claims processor do?
A claims processor reviews, verifies, and processes insurance claims accurately and on time. Day to day, that means checking claims forms for completeness, entering and updating claim data, communicating with policyholders, agents, and providers to gather missing information, applying policy terms under established guidelines, resolving simple discrepancies, working denials and resubmissions, and maintaining accurate records to meet processing deadlines. Complex or questionable claims are escalated to an adjuster or examiner who evaluates and decides them. The role exists across insurance carriers and agencies, medical and dental practices, and billing companies and third-party administrators. In healthcare settings, it overlaps with medical billing and is sometimes titled insurance coordinator or billing coordinator. It is a detail-focused, clerical, hourly role, and it is distinct from a claims adjuster, who decides claim outcomes rather than processing them.
What is the difference between a claims processor and a claims adjuster?
They are different occupations with different pay, classification, and licensing. A claims processor is a clerical role that reviews, verifies, and processes claims under established guidelines, with a federal median wage near $48,450 a year, and it is a non-exempt, hourly position that usually needs only a high school diploma. A claims adjuster, examiner, or investigator is a separate, higher-level occupation that investigates and evaluates claims and decides whether and how much the insurer pays, with a federal median wage of $76,790 in May 2024, and adjusters are often required to hold a state license. A claims examiner sits in that same higher occupation, typically reviewing adjusters' work. In short, a processor handles and routes claims, while an adjuster decides them. Hiring the right one means titling the role correctly, setting pay to match, and including any licensing requirement for an adjuster. Do not advertise a processor role with adjuster duties or pay.
Is a claims processor exempt or non-exempt under the FLSA?
A claims processor is non-exempt and paid hourly. The work is routine clerical processing of claims under established guidelines, and it does not involve the independent judgment on significant matters that the administrative exemption under the Fair Labor Standards Act requires. The Department of Labor treats this kind of clerical work as non-exempt, which means the role is owed overtime at one and a half times the regular rate for hours worked over 40 in a workweek. Importantly, paying a salary above the federal threshold of $684 per week does not by itself make the role exempt, because the duties test still has to be met, and routine claims processing does not meet it. Even a senior processor whose duties remain clerical stays non-exempt. The safe practice for an employer is to pay hourly, track hours, and pay overtime. This is general information, not legal advice.
How much does a claims processor make?
A claims processor earns a median of about $48,450 a year, or roughly $23 an hour, according to federal data for insurance claims and policy processing clerks. Pay generally ranges from the mid $30,000s at the low end to the mid $60,000s at the high end, varying by region, setting, and experience. Entry-level processors start lower, often in the high teens to low twenties per hour, while senior processors reach the mid twenties to low thirties per hour. Medical and dental claims roles fall in a similar band, and dental insurance coordinators in some markets reach the mid thirties per hour. This is well below the wage of a claims adjuster, which has a federal median of $76,790, reflecting the difference between processing claims and deciding them. When posting the role, anchor your range to the federal data, adjust for your market, and include a pay range where your state requires it. This is general information, not legal advice.
Does a medical or dental claims processor need to follow HIPAA?
Yes. A claims processor in a medical or dental practice or a healthcare billing company handles protected health information continuously, which brings the role under HIPAA. The employer must provide HIPAA privacy and security training, limit the processor's access to the minimum information necessary to do the job, and have the processor sign a confidentiality acknowledgment. This applies the same way at a small practice as at a large organization, even when the same person also handles the front desk and patient calls. The practical step is to build HIPAA training and a signed confidentiality acknowledgment into onboarding, completed before the new hire accesses patient records, and to state the HIPAA expectation in the job posting. For general property or casualty insurance claims that do not involve health information, HIPAA does not apply, though confidentiality of policyholder information still does. This is general information, not legal advice.
What qualifications does a claims processor need?
Most claims processor roles require only a high school diploma or equivalent, with one to two years of claims, insurance, billing, or clerical and data-entry experience preferred rather than required. The core competencies are accurate data entry, attention to detail, proficiency with office software and claims or payer systems, and clear written and verbal communication. A medical claims processor benefits from familiarity with CPT, ICD-10, and HCPCS coding and payer portals, and a dental role from CDT codes and dental insurance portals, plus HIPAA knowledge in both. An associate's degree or a billing certificate is a plus but not typically essential, and entry-level roles often require no experience with training provided. Because the role is clerical, hiring should focus on reliability, accuracy, and communication more than on formal credentials. Name the specific systems and any coding knowledge your setting requires so candidates self-select.
Do small insurance agencies and practices hire claims processors in-house?
Yes, frequently, though the title varies. Small independent insurance agencies, medical and dental practices, healthcare billing companies, and small third-party administrators all hire claims processing work as W-2 employees, usually with the owner or office manager doing the hiring rather than an HR department. A common wrinkle is that small offices often advertise the same work under a different title, such as insurance coordinator, billing coordinator, or dental insurance coordinator, rather than claims processor, so it helps to use the title your candidates actually search. While large carriers and offshore outsourcing absorb a meaningful share of claims volume, the in-house hiring at small offices is real and ongoing. The small-office template on this page is written for exactly that hire, where one versatile person owns claims handling and wears several hats on a small team.
What should a claims processor job description include?
A strong claims processor job description names the setting up front, whether general insurance, medical, or dental, since the setting changes the duties and any coding or HIPAA requirements. It should include a clear job summary, responsibilities grouped into review and verify, process and record, communicate, and resolve and escalate, and qualifications centered on data-entry accuracy, the relevant systems, and any coding knowledge. The most valuable additions that generic templates skip are a plain statement that the role is non-exempt and hourly with overtime, a salary range grounded in the federal median, a clear note distinguishing the processor from a higher-paid adjuster, and, in healthcare, the HIPAA expectation. Close with an equal opportunity statement and clear application instructions. Naming the setting, the classification, and these compliance points is what separates a posting that attracts the right candidates from a generic one. This is general information, not legal advice.
