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Remote Claims Adjudicator Jobs (NOW HIRING)

WellSense Health Plan

Claims Adjudicator

$18.27 - $25.72/hr

Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key ... adjudication. · Alerts claims management to claims aging issues as well as provider billing ...

Imagenet

Claims Adjudication Manager

Saint Louis, MO · Remote

Remote Reports To: SVP Operations Direct Oversight: Philippines-based claims adjudication team (examiners, auditors, team leads) Hours: Pacific Time Zone: Core overlap with Philippines business hours ...

ImageNetLLC

Claims Adjudication Manager

Saint Louis, MO · Remote

Remote Reports To: SVP Operations Direct Oversight: Philippines-based claims adjudication team (examiners, auditors, team leads) Hours: Pacific Time Zone: Core overlap with Philippines business hours ...

ImageNetLLC

Claims Examiner - Remote

Tampa, FL · Remote

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...

ImagenetLLC

Claims Examiner - Remote

Tampa, FL · Remote

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...

Imagenet

Claims Examiner - Remote

Tampa, FL · On-site +1

Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · On-site +1

Claims Quality Auditor| Remote Job Type: Full time Work Setup: Remote Reports to: Claims Supervisor ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...

Imagenet

Claims Quality Auditor - Remote

Tampa, FL · Remote

Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...

ImageNetLLC

Claims Quality Auditor - Remote

Tampa, FL · Remote

Remote Reports to: Claims Supervisor Position Summary: TheClaims Quality Auditor plays a key role ... Experience with other claim adjudication platforms and provider systems. * Familiarity with DHCS ...

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Remote Claims Adjudicator information

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$15

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$34

How much do remote claims adjudicator jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for remote claims adjudicator in the United States is $26.74, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $30.29 per hour, depending on experience, location, and employer.

What is the difference between Remote Claims Adjudicator vs Remote Claims Processor?

AspectRemote Claims AdjudicatorRemote Claims Processor
CredentialsTypically requires insurance or healthcare certifications, such as CPC or AHIPOften requires basic insurance knowledge, sometimes certifications but less specialized
Work EnvironmentRemote, independent review of claims, decision-making roleRemote, data entry and processing of claims
Employer & IndustryInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare payers, claims processing centers

While both roles work remotely within the insurance industry, Remote Claims Adjudicators focus on reviewing and making decisions on claims, requiring specialized certifications. Remote Claims Processors handle data entry and processing tasks, often with less certification requirements. The roles differ mainly in decision-making responsibility and required credentials.

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

To thrive as a Remote Claims Adjudicator, you need attention to detail, strong analytical abilities, and a solid understanding of insurance policies or healthcare claims, often backed by relevant experience or industry certification. Familiarity with claims processing software, document management systems, and secure communication tools is typically required. Exceptional written communication, time management, and problem-solving skills allow you to effectively resolve claims and collaborate remotely. These competencies ensure accurate, timely claims decisions and maintain compliance and customer satisfaction in a virtual work environment.

How does working remotely as a Claims Adjudicator impact daily collaboration and communication with the rest of the team?

As a Remote Claims Adjudicator, you'll typically collaborate with team members, supervisors, and related departments through digital platforms like email, instant messaging, and virtual meetings. While you may have fewer in-person interactions, most organizations provide structured check-ins and shared workflow tools to ensure smooth communication and continuous support. This setup allows you to ask questions, share updates, and resolve complex claims collaboratively, even from a distance. Proactive communication and staying organized are key to maintaining productivity and team cohesion in this virtual environment.

What are Remote Claims Adjudicators?

Remote Claims Adjudicators are professionals who review and process insurance claims from a remote location, such as their home or another off-site environment. Their main responsibilities include verifying claim information, ensuring policy compliance, determining claim validity, and calculating payment amounts. They communicate with policyholders, healthcare providers, or other relevant parties as needed, often using digital platforms and secure databases. Working remotely allows them flexibility while maintaining the accuracy and efficiency required in the claims adjudication process.
More about Remote Claims Adjudicator jobs
What cities are hiring for Remote Claims Adjudicator jobs? Cities with the most Remote Claims Adjudicator job openings:
What are the most commonly searched types of Claims Adjudicator jobs? The most popular types of Claims Adjudicator jobs are:
What states have the most Remote Claims Adjudicator jobs? States with the most job openings for Remote Claims Adjudicator jobs include:
What job categories do people searching Remote Claims Adjudicator jobs look for? The top searched job categories for Remote Claims Adjudicator jobs are:
Remote Claims Adjudicator jobs near you
Infographic showing various Remote Claims Adjudicator job openings in the United States as of June 2026, with employment types broken down into 2% Locum Tenens, 2% As Needed, 91% Part Time, and 5% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.
Claims Adjudicator

Claims Adjudicator

WellSense Health Plan

Remote

$18.27 - $25.72/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 13 days ago

WellSense Health Plan rating

8.9

Company rating: 8.9 out of 10

Based on 8 frontline employees who took The Breakroom Quiz

46th of 261 rated insurance

Job description

It’s an exciting time to join the WellSense Health Plan, a growing regional health insurance company with a 25-year history of providing health insurance that works for our members, no matter their circumstances.

Job Summary:

Responsible for the accurate and timely processing of claims.  Must meet published quality and productivity standards.  Also, responsible for simple adjustments to previously processed claims. 

Our Investment in You:

·       Full-time remote work

·       Competitive salaries

·       Excellent benefits

Key Functions/Responsibilities:

·       Evaluates and processes claims in accordance with company policies and procedures according to productivity and quality standards.

·       Interprets and processes routine and less complex claims including CMS 1500 and UB04.

·       Reviews and analyzes data from system-generated reports for in-process claims in order to identify and resolve errors prior to final adjudication.

·       Alerts claims management to claims aging issues as well as provider billing problems.

·       Maintains current knowledge of company members' benefits, policies/procedures, provider network development and contract issues, processing system issues, Massachusetts Medicaid regulations, as well as industry standards for claims adjudication.

·       Consistently maintains production standards based on transactions/units per hour

·       Consistently meets quality standards 

Qualifications: 

Education:

·       High School degree or equivalent required.

·       Associate degree or some college coursework preferred.

Experience:

·       Two years or more years experience in managed care claims processing preferred.

Competencies, Skills, and Attributes:

·       Working knowledge of medical terminology as well as CPT4, HCPCS and ICD9 coding sets and HIPAA regulations.

·       Familiarity with UB04's and CMS 1500's

·       Knowledge of Microsoft Office and FACETS preferred.

·       Ability to maintain production level and quality goals.

·       Follow through on commitments and meets deadlines

·       Work is thorough, accurate, and effective.

·       Demonstrates ability to complete assigned work in a timely fashion.

Working Conditions and Physical Effort:

·       Ability to work OT during peak periods.

Compensation Range 

$18.27- $25.72

This range offers an estimate based on the minimum job qualifications.  However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer.  This includes education, experience, skills, and certifications/licensure as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, WellSense offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family wellbeing.  

Note: This range is based on Boston-area data, and is subject to modification based on geographic location. 

About WellSense

WellSense Health Plan is a nonprofit health insurance company serving more than 740,000 members across Massachusetts and New Hampshire through Medicare, Individual and Family, and Medicaid plans. Founded in 1997, WellSense provides high-quality health plans and services that work for our members, no matter their circumstances. WellSense is committed to the diversity and inclusion of staff and their members.

Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status. WellSense participates in the E-Verify program to electronically verify the employment eligibility of newly hired employees


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