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Fraud Claims Work From Home Jobs (NOW HIRING)

Randstad

Claims WFH - Health Insurance

Houston, TX · Remote

$21 - $23/hr

HIRING NOW - WFH CLAIMS SPECIALIST We are seeking a detail-oriented and experienced Claims ... Review claims for possible fraud and abuse, referring them to the Special Investigations Unit when ...

Zurich Insurance Group

Claims Fraud Investigator

AZ · Remote

The ideal candidate for this role will have the opportunity to work fully remote from one of the ... Knowledge of claims processes and relevant fraud related regulations * Proficiency in Microsoft ...

Zurich Insurance Group

Claims Fraud Investigator

UT · Remote

The ideal candidate for this role will have the opportunity to work fully remote from one of the ... Knowledge of claims processes and relevant fraud related regulations * Proficiency in Microsoft ...

Zurich Insurance Group

Claims Fraud Investigator

CA · Remote

The ideal candidate for this role will have the opportunity to work fully remote from one of the ... Knowledge of claims processes and relevant fraud related regulations * Proficiency in Microsoft ...

Zurich Insurance Group

Claims Fraud Investigator

NV · Remote

The ideal candidate for this role will have the opportunity to work fully remote from one of the ... Knowledge of claims processes and relevant fraud related regulations * Proficiency in Microsoft ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

The Jernigan Agency

WORK FROM HOME

Chula Vista, CA · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Grand Rapids, MI · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Kansas City, KS · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Oklahoma City, OK · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

AO Globe Life

Work From Home

Virginia Beach, VA · On-site +1

Join our fully virtual, work-from-home team where you can earn an exceptional income while still cherishing every precious moment with your loved ones. With the freedom to set your own hours, you can ...

The Jernigan Agency

WORK FROM HOME

Antioch, TN · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

The Jernigan Agency

WORK FROM HOME

Bridgeport, CT · On-site +1

$300 - $500/wk

We are looking for individuals interested in working from home, remotely, as life insurance sales representatives. We are hiring coachable individuals comfortable with a 100% commission based income ...

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Fraud Claims Work From Home information

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How much do fraud claims work from home jobs pay per hour?

As of Jul 19, 2026, the average hourly pay for fraud claims work from home in the United States is $19.85, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.63 per hour, depending on experience, location, and employer.

What are Fraud Claims Work From Home jobs?

Fraud Claims Work From Home jobs are remote positions where employees investigate, review, and process claims related to suspected fraudulent activity, typically for financial institutions or insurance companies. Workers in these roles analyze transaction data, interview customers, and collaborate with other departments to resolve fraud cases, all while working from a home office. This job requires strong attention to detail, analytical skills, and the ability to communicate clearly with clients and colleagues. Many employers provide training and necessary equipment for remote work. These positions are suitable for individuals seeking flexibility and a secure work environment.

What are some common challenges faced by Fraud Claims professionals working from home, and how can they be addressed?

Fraud Claims professionals working remotely often face challenges such as maintaining secure access to sensitive information, staying updated on evolving fraud schemes, and feeling connected to their team. To address these, companies provide robust cybersecurity tools, regular training on the latest fraud trends, and virtual team meetings to ensure collaboration and support. Setting up a dedicated, secure workspace and maintaining open communication with supervisors and colleagues can further help manage these challenges and ensure productivity.

What are the key skills and qualifications needed to thrive as a Fraud Claims Work From Home specialist, and why are they important?

To thrive as a Fraud Claims Work From Home specialist, you need strong analytical skills, attention to detail, and experience in fraud detection or financial services, often supported by a relevant associate’s or bachelor’s degree. Familiarity with fraud management software, case management systems, and sometimes certifications like CFE (Certified Fraud Examiner) are typically valued. Excellent communication, problem-solving abilities, and self-motivation are crucial soft skills for success in a remote environment. These competencies enable accurate fraud identification, efficient resolution of claims, and ensure compliance while working independently from home.
More about Fraud Claims Work From Home jobs
What cities are hiring for Fraud Claims Work From Home jobs? Cities with the most Fraud Claims Work From Home job openings:
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Fraud Claims Work From Home jobs near you
Claims WFH - Health Insurance

Claims WFH - Health Insurance

Randstad

Houston, TX • Remote

$21 - $23/hr

Full-time

Posted 3 days ago

Job description

HIRING NOW – WFH CLAIMS SPECIALIST

We are seeking a detail-oriented and experienced Claims Specialist to join a leader in the health insurance industry. In this role, you will be responsible for processing, adjusting, and updating moderate to complex claims payments and payment errors. You will act as a key point of contact for resolving inquiries from customer service professionals, subscribers, providers, physicians, and other insurance carriers, ensuring all claims are handled accurately and efficiently.

Position Details

  • Schedule: Monday – Friday, 8:00 AM – 5:00 PM EST.
  • Location: 100% Remote (Available to candidates residing in 28 approved states)
  • Compensation: $21 - $23/hour (based on years of experience).

Key Responsibilities

  • Process, adjust, and update various moderate to complex claims payments for any business segment and provider type. Determine suspended claim resolution methods by reviewing benefit eligibility and claims history.
  • Process Medicare claims, review DTPs, and utilize Facets for Medicare Advantage and Medicare Supplement claims.
  • Meet or exceed established quality and performance standards. Daily production goals are based on an hourly target of 7 claim pends, 7 COB pends, and 4 CSI/ADJ.
  • Respond promptly and accurately to inquiries from internal and external stakeholders. Coordinate with other insurance carriers and Medicare to determine payment liability.
  • Escalate claims requiring specialized resolution to subject matter experts (SMEs). Review claims for possible fraud and abuse, referring them to the Special Investigations Unit when necessary.
  • Identify and document system issues, recommending potential solutions to technical staff. Use your knowledge of claims to drive efficiency, production gains, and share best practices.

Qualifications & Requirements

  • High School Diploma or GED
  • 3+ years of experience processing Insurance Claims.
  • Proven experience processing Medicare Advantage and Medicare Supplement claims.
  • Experience running and navigating Facets, as well as reviewing DTPs.
  • Strong analytical skills, excellent communication, and the ability to maintain high accuracy in a production-driven environment.

TO APPLY: Email Resume to: claudia.mendoza@randstadusa.com

If this job is not for you, feel free to refer a friend.


Skills

  • Claims
  • Claims Processing
  • Insurance
  • health insurance
  • claims processor
  • medicare
  • COB
  • facets
  • TriZetto
  • claims analyst

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.


Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.
At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.
Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).
This posting is open for thirty (30) days.