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Remote Claim Processor Jobs (NOW HIRING)

The MH Group, LLC

$60K - $70K/yr

This is a fully remote position with a great company offering fantastic benefits. The Claims Compliance Analyst is responsible for maintaining a deep knowledge of the claim processes, can process ...

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How much do remote claim processor jobs pay per hour?

As of Jun 1, 2026, the average hourly pay for remote claim processor in the United States is $19.16, according to ZipRecruiter salary data. Most workers in this role earn between $16.35 and $20.67 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Claim Processor, and why are they important?

To thrive as a Remote Claim Processor, you need strong analytical skills, attention to detail, and a background in insurance or healthcare administration, typically supported by a high school diploma or relevant certification. Familiarity with claims management software, electronic health record (EHR) systems, and Microsoft Office is crucial for daily tasks. Excellent communication, problem-solving abilities, and self-motivation help remote claim processors efficiently resolve issues and work independently. These skills ensure accurate claims processing, timely resolution, and high customer satisfaction in a remote environment.

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

Remote claim processors often encounter challenges such as maintaining effective communication with team members and staying up-to-date with changing insurance policies and procedures. To manage these challenges, it's important to leverage collaboration tools like instant messaging and video conferencing, and to participate actively in virtual training sessions. Additionally, setting up a dedicated workspace and following a structured daily routine can help ensure productivity and accuracy when processing claims remotely.

What is a Remote Claim Processor?

A Remote Claim Processor is a professional who reviews, evaluates, and processes insurance claims from a remote location, often from home. They verify the accuracy of submitted information, ensure policy guidelines are met, and decide whether claims should be approved, denied, or require further investigation. This role typically involves working with health, auto, or property insurance claims and requires strong attention to detail, analytical skills, and familiarity with relevant software systems. Working remotely allows claim processors to handle their duties outside of a traditional office environment while maintaining communication with their team and clients through digital platforms.

What is the difference between Remote Claim Processor vs Remote Claims Examiner?

AspectRemote Claim ProcessorRemote Claims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or healthcare certificationsHigh school diploma or equivalent; often requires insurance or healthcare-related certifications
Work EnvironmentHome-based, independent work settingHome-based, independent work setting
Industry UsageInsurance, healthcare, government agenciesInsurance, healthcare, government agencies
Job FocusProcessing insurance claims, data entry, verifying informationReviewing and adjudicating insurance claims, ensuring compliance

Both roles are remote positions within the insurance and healthcare industries, requiring similar credentials and work environments. The main difference lies in their focus: Remote Claim Processors handle initial claim processing and data entry, while Remote Claims Examiners review and make decisions on claims to ensure accuracy and compliance.

More about Remote Claim Processor jobs
What cities are hiring for Remote Claim Processor jobs? Cities with the most Remote Claim Processor job openings:
What states have the most Remote Claim Processor jobs? States with the most job openings for Remote Claim Processor jobs include:
What job categories do people searching Remote Claim Processor jobs look for? The top searched job categories for Remote Claim Processor jobs are:
Remote Claim Processor jobs near you
Infographic showing various Remote Claim Processor job openings in the United States as of May 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $39,863 per year, or $19.2 per hour.
Claims Auditor- Remote

Claims Auditor- Remote

American Health Partners

Franklin, TN • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 23 days ago

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com.
If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!
Benefits and Perks include:
  • Affordable Medical/Dental/Vision insurance options
  • Generous paid time-off program and paid holidays for full time staff
  • TeleMedicine 24/7/365 access to doctors
  • Optional short- and long-term disability plans
  • Employee Assistance Plan (EAP)
  • 401K retirement accounts
  • Employee Referral Bonus Program

ESSENTIAL JOB DUTIES:
To perform this job, an individual must accomplish each essential function satisfactorily, with or without a reasonable accommodation.
  • Conduct pre-pay and post-pay audits to ensure accurate claims payments and denials
  • Ensure regulatory compliance and overall quality and efficiency by utilizing strong working knowledge of claims processing standards
  • Work closely with delegated claim processor to ensure errors are reviewed and corrected prior to final payment
  • Work assigned claim projects to completion
  • Provide a high level of customer service to internal and external customers; achieve quality and productivity goals
  • Escalate appropriate claims/audit issues to management as required; follow departmental/organizational policies and procedures
  • Maintain production and quality standards as established by management
  • Participate in and support ad-hoc audits as needed
  • Other duties as assigned

JOB REQUIREMENTS:
  • Proficient in processing/auditing claims for Medicare and Medicaid plans
  • Strong knowledge of CMS requirements regarding claims processing, especially regarding skilled nursing facilities and other complex claim processing rules and regulations
  • Current experience with both Institutional and Professional claim payments
  • Knowledge of automated claims processing systems
  • Hybrid role that may require 2-3 days per week onsite at the Franklin, TN office.

REQUIRED QUALIFICATIONS:
  • Experience:
    • Two (2) years' experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system
    • Two (2) years' experience in managed healthcare environment related to claims processing/audit
    • Two (2) years' experience with standard coding and reference materials used in a claim setting, such as CPT4, ICD10 and HCPCS
    • Two (2) years' experience with CMS requirements regarding claims processing; especially Skilled Nursing Facility and other complex claim processing rules and regulations
    • Two (2) years' experience processing/auditing claims for Medicare and Medicaid plans
  • License/Certification(s):
    • Coding certification preferred

EQUAL OPPORTUNITY EMPLOYER
Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.
This employer participates in E-Verify.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.
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About American Health Partners

Sourced by ZipRecruiter

American Health Partners is a family of six divisions staffed by outstanding employees who care deeply about others. Since our inception more than 45 years ago, we have been committed to bringing the highest quality healthcare available to our communities. That commitment continues to serve us, our patients, our customers and our partners well. Today, our diverse healthcare offerings serve nearly 12,000 individuals annually across multiple states. We operate in both urban and rural communities where people need healthcare close to home. By working closely with hospitals and other providers, we offer cost-effective options that give individuals greater control over their healthcare.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Franklin, TN, US

Year founded

1976

Social media

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