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Claims Adjudication Remote Jobs (NOW HIRING)

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 ...

Sentara

Senior Data Analyst - Remote

Norfolk, VA · Remote

$83K - $105K/yr

This position is fully remote. Overview The Senior Data Analyst supports the Batch Reprocessing and ... Working across multiple claims adjudication platforms and the team's ticketing and data warehouse ...

Sentara Healthcare

Senior Data Analyst - Remote

Norfolk, VA · On-site +1

$83K - $105K/yr

This position is fully remote. Overview The Senior Data Analyst supports the Batch Reprocessing and ... Working across multiple claims adjudication platforms and the team's ticketing and data warehouse ...

Sierra Solutions

QA Specialist- REMOTE

... claims adjudication outcomes against expected business rules. • Work closely with configuration specialists, business analysts, developers, and business stakeholders to resolve issues. • ...

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$15

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How much do claims adjudication remote jobs pay per hour?

As of Jun 16, 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 87% Full Time, and 13% Part Time. Highlights an 100% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.
Government Programs Professional Review Claims Specialist

Government Programs Professional Review Claims Specialist

Delta Dental of Michigan

Okemos, MI • On-site, Remote

Full-time

Medical, Dental

This job post has expired today. Applications are no longer accepted.

Job description

Job Title:
Government Programs Professional Review Claims Specialist
Number of Positions:
1
Location:
Okemos, MI
Location Specifics:
Fully Remote
Job Summary:
Candidates must reside in Michigan within a reasonable commuting distance of our Okemos, MI office for team meetings, collaborative sessions, and training.
At Delta Dental of Michigan, Ohio, and Indiana we work to improve oral health through benefit plans, advocacy and community support, and we amplify this mission by investing in initiatives that build healthy, smart, vibrant communities. We are one of the largest dental plan administrators in the country, and are part of the Delta Dental Plans Association, which operates two of the largest dental networks in the nation.
At Delta Dental, we celebrate our All In culture. It's a mindset, feeling and attitude we wrap around all that we do - from taking charge of our careers, to helping colleagues and lending a hand in the community.
Position Description
To analyze and adjudicate dental claims with complicated treatment plans to ensure accurate benefits administration.
Primary Job Responsibilities
  • Analyzes and processes dental claims so appropriate determinations can be finalized with correct procedures, policies, and bypasses; adjudicates claims, and maintains claim records.
  • Administers claim processing guidelines/standards, Delta USA processing policies, group contracts, provider agreements, and state laws applicable to claims adjudication.
  • Investigates difficult provider reconsideration requests, makes determinations, performs or coordinates adjustments; prepares claims for a second and/or third opinion when necessary and consults with contracted dentists on questionable treatment cases.
  • Pre and post-screens claims and/or inquiries for dental consultant(s); reviews and prepares claims for and coordinates external dental consultant activities.
  • Provides dental expertise and/or interpretation of dental policies, procedures codes, and processing guidelines to internal and external contacts.
  • Organizes, creates, and performs defined test cases on claims processing system, and documents/reports status of testing including recommendations for improvements. Analyzes and compiles information/data for reports to control and/or monitor claims inventory.
  • Researches, coordinates, and adjudicates Third Party Liability claims and recoveries; compares member information, prepares claims, and performs adjustments as necessary to ensure proper Third Party Liability (COB) adjudication.

Perform other related assigned duties as necessary to complete the Primary Job Responsibilities as described above.
#LI-Remote
Minimum Requirements:
Position requires an associate's degree, technical, vocational, or business school with coursework related to dentistry, two years of experience in chair side assisting, and a RDA or RDH licensure. Will accept any suitable combination of education, training, or experience.
Position requires advanced knowledge of dental terminology and dental procedures and the ability to read and interpret radiographs, electronic images and photos; experience working with word processing and spreadsheet software; effective verbal and written communication skills; ability to resolve complex problems and use independent judgment; experience with provider system; client contracts and Roosevelt is preferred.
The company will provide equal employment and advancement opportunity within the context of its unique business environment without regard to race, color, religion, gender, gender identity, gender expression, age, national origin, familial status, citizenship, genetic information, disability, sex, sexual orientation, marital status, pregnancy, height, weight, military status, or any other status protected under federal, state, or local law or ordinance.

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