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Remote Claims Adjudicator Jobs (NOW HIRING)

Sourcedge Solutions

FACETS Claims Processor

Albany, NY · Remote

$17 - $21.25/hr

Remote Reply at: Jobs@sourcedge.com FACETS SENIOR CLAIMS PROCESSOR * 5 Years Facets Claims Adjudication Experience * The Claims Examiner must maintain production and inventory standards compliant ...

NTT Data Americas, Inc.

Medical Claims Processor

$17 - $18/hr

... adjudicated as per clients defined workflows, guidelines • Sustaining and meeting the client ... The starting hourly range for this remote role is $17.00-18.00. This range reflects the minimum and ...

RoadVantage

Ancillary Claims Supervisor

Austin, TX · On-site +1

Remote Monday and Friday, subject to business needs and management approval) Job Purpose The ... This role ensures timely, accurate claim adjudication while driving performance against key service ...

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Remote Claims Adjudicator information

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How much do remote claims adjudicator jobs pay per hour?

As of Aug 8, 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?

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 is a remote claims adjudicator?

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 August 2026, with employment types broken down into 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 84% Physical, 5% Hybrid, and 11% Remote job distribution, with an average salary of $55,623 per year, or $26.7 per hour.

FACETS Claims Processor

Sourcedge Solutions

Albany, NY • Remote

$17 - $21.25/hr

Contractor

Posted 25 days ago

Job description

Location: Remote 
Reply at: Jobs@sourcedge.com
FACETS SENIOR CLAIMS PROCESSOR 
Job Description:
 
  • 5 Years Facets Claims Adjudication Experience
 
  • The Claims Examiner must maintain production and inventory standards compliant with Claims Administration requirements
 
  • High school diploma or equivalent required
 
  • Must have 5+ years of relevant claim processing experience in healthcare industry (managed care or TPA Company) to support our clients
 
  • Possess high productivity and quality standards within a claims processing automation environment
 
  • Knowledge of CPT, HCPC, ICD-10 codes
 
  • Knowledge of HMO, PPO, Medicare and Medicaid plans
 
  • Knowledge of Medical terminology
 
  • Computer with 2 Monitors
 
  • High Speed Internet Connection
 
  • Ability to work remote 8 hour day, Mon-Fri.

Responsibilities:
 
  • The claims examiner is responsible for accurate and timely adjudication of claims for the Health Plans lines of business
 
  • Primary duties include analysis and resolution of claims, including reviewing pended claims and manually resolving based on client specified direction and criteria, including  third-party liability claims
 
  • The claims examiner must be able to work independently, effectively prioritizing work in a production environment that frequently changes to meet production standards and contractual requirements
 
  • Success in this position will be based on the individual's ability to effectively prioritize work, identify, and resolve complex concerns in a professional manner, and work in a team environment to achieve and maintain production and audit standards
 
  • Timely and accurate processing and adjudication of all types of claims from assigned workflow queues
 
  • Compliance with state, federal and contractual requirements to Claims Administration
 
  • Demonstrate a thorough knowledge of the Plan's claims processing procedures as provided in training materials and proficiency with the core and ancillary system applications
 
  • Demonstrates the ability to think analytically to resolve complicated claim issues and identify appropriately when to escalate issues for review
 
  • Ability to review and apply Plan directives and desktop procedures to claims, following step by step guidelines
 
  • Claim analysis of coding and billing compliance, potential third-party liability, accurate coordination of benefits (COB), benefit application including limitations and restrictions, pre-existing conditions, subrogation, medical necessity and other claim investigation as appropriate
 
  • Complete all mandatory claims training/refresher courses
 
  • Actively participates and supports department and organization-wide efforts to improve efficiencies while supporting departmental goals and objectives
 
  • Complete all mandatory compliance and corporate training
 
  • Must be able to adapt to a changing work priorities and requirements and perform other duties as directed to support the overall functions of Claims Administration and support of staff without boundaries within the Plan