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Claims Adjudication Remote Jobs (NOW HIRING)

RoadVantage

Ancillary Claims Supervisor

Austin, TX · On-site +1

Remote Monday and Friday, subject to business needs and management approval) Job Purpose The ... This role ensures timely, accurate claim adjudication while driving performance against key service ...

Link Up Overseas

Customer Service Representative (Remote)

$16.50 - $22.25/hr

Customer Service Representative (Remote) Indianapolis, IN, United States Or refer someone Job ... Submit claims for adjudication, correction, payment, or review as appropriate. * Educate providers ...

Apolis

Be Seen First

Claims Intake Coordinator (Remote)

Los Angeles, CA · Remote

$16 - $18/hr

Knowledge of CMS grievance and appeals processes, healthcare billing, and claims adjudication is preferred. Company Description Apolis is in an effort to help promising individuals realize their ...

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Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · Remote

Remote Reporting to: Claims Supervisor About the Role We are seeking a highly driven Healthcare ... Imagenet provides claims processing services, including digital transformation, claims adjudication ...

Imagenet

Healthcare Claims Team Lead - Remote

Tampa, FL · On-site +1

Remote Reporting to: Claims Supervisor About the Role We are seeking a highly driven Healthcare ... Imagenet provides claims processing services, including digital transformation, claims adjudication ...

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How much do claims adjudication remote jobs pay per hour?

As of Jul 4, 2026, the average hourly pay for claims adjudication remote in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Adjudication Remote specialist, and why are they important?

To thrive as a Claims Adjudication Remote specialist, you need a solid understanding of insurance policies, medical terminology, and claims processing, often supported by a high school diploma or relevant experience. Familiarity with claims management software, electronic data interchange (EDI) systems, and occasionally industry certifications like AAPC or AHIMA is beneficial. Attention to detail, analytical thinking, and strong communication skills help ensure accuracy and effective collaboration with team members and clients. These skills are essential for timely and accurate claims processing, minimizing errors, and maintaining regulatory compliance in a remote work environment.

What is claims adjudication in a remote job setting?

Claims adjudication is the process of reviewing and processing insurance claims to determine their validity and the amount payable to policyholders. In a remote setting, claims adjudicators use specialized software and secure access to company databases to evaluate claims from home or another remote location. They verify the details of each claim, check compliance with policy terms, and communicate with clients or healthcare providers as needed. Remote claims adjudicators must be detail-oriented, have strong analytical skills, and maintain confidentiality while handling sensitive information.

What are some common challenges faced by remote claims adjudicators, and how can they be effectively managed?

Remote claims adjudicators often encounter challenges such as maintaining clear communication with team members, staying updated with frequently changing policies, and managing a high volume of complex cases independently. To manage these effectively, it's important to leverage collaboration tools, participate in regular virtual team meetings, and stay proactive in seeking clarification on policies or procedures. Additionally, strong organizational skills and self-discipline are crucial for meeting deadlines and maintaining accuracy in remote settings.
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Claims Adjudication Remote jobs near you
Infographic showing various Claims Adjudication Remote job openings in the United States as of June 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 100% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.
Business Analyst (Policy remediation) - Contract - Remote

Business Analyst (Policy remediation) - Contract - Remote

SUNSHINE ENTERPRISE USA LLC

Columbia, SC • Remote

Contractor

Posted 6 days ago

Job description

Business Analyst (Policy remediation) Location: Remote Interview Process: 1 round, virtual Duration: 12 Months Employment Type: Contract Experience Required: 05+ Years Candidate Location: Candidate MUST be a SC resident. No relocation allowed. Project Scope: We are seeking an experienced Business Analyst with expertise in policy remediation, medical coding, and healthcare claims systems.

This role will serve as a subject matter expert (SME) supporting policy and operational initiatives related to medical coding compliance, claims adjudication, and system change management. The ideal candidate will leverage deep knowledge of ICD-10, CPT, and HCPCS coding methodologies, as well as Medicaid and payer operations, to ensure alignment between policy updates, coding changes, and system functionality. This position will play a critical role in supporting compliance initiatives, regulatory updates, and business process improvements.

Key Responsibilities: Serve as a subject matter expert (SME) for medical coding methodologies, Medicaid policy, and claims adjudication processes. Analyze annual, quarterly, and ad hoc coding updates, including ICD-10, CPT, and HCPCS changes. Review and assess the impact of coding and policy changes on business processes, system functionality, and claims outcomes.

Collaborate with business stakeholders, policy teams, and technical teams to define requirements and implement necessary system changes. Support change requests and ensure system updates produce accurate and expected claims adjudication results. Research business rules, requirements, and process models to develop recommendations and solutions.

Maintain and update business rules, requirements documentation, and process models in designated repositories. Lead meetings with stakeholders, business owners, and cross-functional teams. Participate in policy remediation efforts, compliance initiatives, and related enterprise projects.

Ensure process documentation, training materials, and supporting documentation are complete and up to date. Collaborate with internal teams to support ongoing operational and regulatory compliance. Provide expertise in medical coding software, claims systems, and healthcare policy interpretation.

Required Skills & Experience: Minimum of 5 years of experience in healthcare insurance, medical review, program integrity, or appeals. At least 5 years of experience working with IT developers and programmers in a payer environment. Minimum of 5 years of hands-on experience in medical coding within a payer environment.

Strong expertise in ICD-10, CPT, and HCPCS coding methodologies and translation. Minimum of 5 years of experience with medical claims processing systems. Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint).

Experience using Optum Encoder or similar medical coding software. Strong analytical, problem-solving, and critical-thinking skills. Excellent written and verbal communication skills.

Preferred Skills: Minimum of 5 years of experience in policy remediation. At least 3 years of clinical experience in a healthcare environment. Strong clinical assessment and critical-thinking skills.

Experience with Medicaid programs and Medicaid Management Information Systems (MMIS). Familiarity with healthcare regulatory compliance and policy implementation. Technical Skills Medical Coding and Reimbursement, ICD-10, CPT, and HCPCS Expertise, Policy Remediation and Compliance, Claims Adjudication and Processing, Medicaid and MMIS Knowledge, Business Requirements Analysis, Process Documentation and Improvement, Stakeholder Engagement and Facilitation, Regulatory and Operational Compliance, Cross-Functional Collaboration Education: Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field.

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