Remote Medical Claims Processor

About the Role

Step into a role where accuracy and impact converge. As a Remote Medical Claims Processor, you'll be responsible for reviewing, verifying, and authorizing insurance claims related to medical treatments. This work-from-home opportunity offers flexibility while enabling you to make a meaningful difference in the healthcare system. You’ll be part of a high-performance remote team focused on optimizing claim cycles, improving operational reliability, and supporting patients’ access to care.

Key Responsibilities

Core Duties

• Examine incoming medical claims for correctness and policy alignment
• Apply coding systems, including ICD-10, CPT, and HCPCS, with precision
• Confirm eligibility by analyzing insurance coverage data
• Investigate claims discrepancies and initiate resolution workflows
• Maintain documentation within digital claims management systems
• Ensure alignment with payer rules and healthcare regulations
• Monitor status updates and proactively reduce claim cycle time
• Cross-check supporting documents with submitted procedures

Communication and Coordination

• Collaborate with internal billing and compliance teams to resolve flagged items.
• Respond to requests for information from healthcare providers and insurance reps.
• Provide claim status reports using secure messaging systems
• Offer guidance on Explanation of Benefits (EOBs) to patients or reps when needed
• Assist in audits and quality control efforts by sharing relevant documentation

Required Skills and Qualifications

Education and Experience

• High school diploma is required; post-secondary coursework in health administration is a plus
• 2+ years of hands-on experience in healthcare claims processing or billing
• Familiarity with both government and private insurance plans
• Certification in billing/coding (CPC, CPB, or similar) is a strong advantage

Competencies and Knowledge

• In-depth understanding of insurance claim procedures and healthcare documentation
• Proficient in navigating CMS-1500, UB-04, and other standard forms
• Comfortable with digital workflows and health record systems
• Strong grasp of HIPAA laws and confidentiality practices
• An analytical mindset with attention to billing anomalies or patterns

Tools and Technology

• Digital billing software (e.g., AdvancedMD, Kareo, or equivalent)
• Claims clearinghouses and payer portals
• Microsoft Excel and cloud-based spreadsheets for reporting
• VPN-secured systems for remote login and task tracking
• Communication platforms such as Zoom, Google Meet, and Slack

Work Environment

Remote Setup

You will work from your home office with tools provided to support efficiency and compliance. A distraction-free environment, dual-monitor setup, and stable internet connection are required.

Collaborative Culture

• Weekly team calls to track progress and address blockers
• Access to a knowledge base and internal forums for guidance
• Performance dashboards to help track your metrics and progress

Peer and Manager Support

• Virtual open office hours with team leads
• Regular one-on-ones for performance feedback and development
• Inclusion in team-wide training and system updates

What Success Looks Like

Measurable Outcomes

• Maintain a claims accuracy rate of 98% or higher
• Resolve claim discrepancies within SLA timeframes
• Achieve daily and weekly processing volume targets

Broader Contribution

• Reduce administrative delays in patient reimbursements
• Enhance payer-provider relationships through accurate claims
• Support the integrity of healthcare data processing

Benefits and Perks

• Annual salary of $40,493
• 100% remote with flexible hours to suit your lifestyle
• PTO, sick days, and all major holidays off
• Health, dental, and vision insurance with customizable options
• Employer-contributed retirement plan
• Learning stipends and certification reimbursement
• Opportunities to join internal task forces or lead special projects

Career Growth

Career development is a key focus of this role. As you demonstrate consistency, reliability, and initiative, you'll gain opportunities for professional advancement.

Internal Mobility

• Step into senior processor or auditor roles
• Transition into QA, compliance, or systems roles
• Train and mentor new hires through onboarding programs

Impact and Purpose

Your attention to detail ensures legitimate, timely reimbursements. Your accuracy reduces delays and costs within the health ecosystem. In this role, your decisions help maintain balance between policyholders, payers, and providers.

Ethical Contribution

• Uphold high standards for claim review and integrity
• Help minimize fraudulent claims through vigilance
• Contribute to a trustworthy and resilient healthcare system

Call to Action

If you're ready to bring clarity, speed, and precision to the healthcare claims process—all while working remotely—this position is for you. Apply today and become an essential part of the system that supports better healthcare for everyone.