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Remote Claim Processor Jobs in Raleigh, NC (NOW HIRING)

Pharmacy Technician

Cary, NC · On-site +1

$22.50/hr

Process pharmacy claims through Biologics MIS and interpret claim responses to determine next steps ... for remote work based on business needs. Hours fall between 8:00 AM and 8:00 PM Eastern Time ...

Showing results 21-22

Remote Claim Processor information

See Raleigh, NC salary details

$11

$18

$25

How much do remote claim processor jobs pay per hour?

As of Aug 10, 2026, the average hourly pay for remote claim processor in Raleigh, NC is $18.63, according to ZipRecruiter salary data. Most workers in this role earn between $15.87 and $20.10 per hour, depending on experience, location, and employer.

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.

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 skills and qualifications are needed to thrive as a remote claim processor?

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 common challenges faced by remote claim processors, and how can they be managed?

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 cities near Raleigh, NC are hiring for Remote Claim Processor jobs? Cities near Raleigh, NC with the most Remote Claim Processor job openings:
Infographic showing various Remote Claim Processor job openings in Raleigh, NC as of August 2026, with employment types broken down into 78% Full Time, 19% Part Time, and 3% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution, with an average salary of $38,750 per year, or $18.6 per hour.

Clinical Specialty Program Pharmacist - Remote

UnitedHealth Group

Durham, NC • On-site, Remote

$114K - $136K/yr

Full-time

Retirement

Re-posted 8 days ago


UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

186th of 887 rated healthcare providers


Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
Lead and manage ongoing client relationships, pharmacy benefit analysis and consultation delivery to clients. Collaborate in development of strategy as outward-facing, dedicated resources for assigned accounts, typically with direct client contact for large/complex accounts. Builds client relationships and serves as primary point of contact for clinical specialty pharmacy needs. Represents client(s) internally and coordinates with other functions to implement client systems, complete projects, and address ongoing pharmacy service needs.
The Clinical Specialty Program Pharmacist are responsible for Specialty execution on all clinical strategies, patient care support, Specialty Drug List consultation and quality initiatives. The Clinical Specialty Program Pharmacists shall participate in quarterly business reviews detailing pipeline tracking, including forecasting, key performance indicator (KPI) review, strategic guidance, and comprehensive medical management initiatives.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Support routine reporting to client management leadership regarding milestone attainment and any significant issues within their segment that may be impacting overall team performance
  • Maintains understanding of individual client contracts and ensures proper execution of all relevant deliverables specific to those agreements
  • Work with the Client Management Leadership Team to drive and execute toward strategic goals and objectives
  • Collaborates with clients to establish achievable but aggressive specialty program goals, including support on patient care support, Specialty Drug list consultation and quality initiatives
  • Formulates and delivers clinically-sound and fiscally responsible recommendations to clients based on trend
  • Create action plans to address any client satisfaction concerns
  • Stays aware of and provides market intelligence to clients on specialty pharmacy products
  • Provides education for clients, pharmacists, members and physicians per contractual requirements
  • Supports strategies around other revenue-enhancement efforts (e.g., specialty, formulary, UM, mail, etc.) in coordination with client mgmt./sales teams where appropriate
  • Routinely collaborates with client management leadership peers to provide well-coordinated, impactful quarterly performance review sessions with clients
  • Serves a key resource for new clinical product/service ideation and liaison to clinical product development / management areas to create new or enhance existing programs
  • Identifies and collaborates with clinical management leadership on specialty management strategies
  • Drives enhanced client relationships through senior-level strategic discussions and planning which addresses issues of highest priority for the client
  • Consistently looks at existing processes, methods, and materials to find opportunities for improvement
  • Maintains strategic relationships with client leaders, key stakeholders, and brokers/consultants
  • Serves as Subject Matter Expert (SME) for other departments on Specialty Pharmacy-specific issues/inquiries
  • Lead departmental and interdepartmental workgroup and project work

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Bachelor of Science in Pharmacy or PharmD
  • Active, unrestricted US state-specific pharmacist license
  • 2+ years of experience in PBM
  • Experience with specialty pharmacy
  • Experience with total cost of care
  • Advanced proficiency in delivering presentations to various audiences
  • Proficient skills in Microsoft Office and Outlook
  • Willing to work with clients and colleagues across various time zones
  • Ability to travel up to 10%

Preferred Qualifications:
  • 2+ years of PBM operations experience
  • 2+ years of experience supporting PBM Healthplan clients
  • Experience giving formal presentations
  • Experience in data analytics and drawing insights
  • Experience in Rx Claim
  • Experience in MediSpan
  • Advanced understanding of PBM industry

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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