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Remote Claims Analyst Jobs (NOW HIRING)

Lloyds Banking Group

Claims Field Consultant

Remote. Please note: We have sites in Halifax, Leeds and South Wales - frequent travel to these ... analysing data from site inspection, photos/videos content and other sources, using a variety of ...

NTT DATA Services

Claims Examiner Remote

Plano, TX · On-site +1

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and ... analysis and problem-solving abilities • Time management with the ability to cope in a complex ...

NTT DATA Services

Claims Examiner Remote

Plano, TX · On-site +1

NTT DATA is seeking to hire a Remote Claims Processing Associate to work for our end client and ... analysis and problem-solving abilities Time management with the ability to cope in a complex ...

Luminare Health

Sr Claims Analyst - LHB

In addition to these tasks, the Senior Claims Analyst is responsible for all of the same tasks as a Claim Analyst including the accurate adjudication and processing of medical, dental, vision, or ...

Network Health

Claims Analyst II

Menasha, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health, Inc

Claims Analyst II

Menasha, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health

Claims Analyst II

Brookfield, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

Network Health, Inc

Claims Analyst II

Brookfield, WI · On-site +1

We are seeking a Claims Analyst II to examine and process paper and electronic claims. In this role, you will determine whether to return, pend, deny, or pay claims in accordance with established ...

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How much do remote claims analyst jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote claims analyst in the United States is $27.39, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $31.49 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a remote claims analyst?

Excelling as a Remote Claims Analyst requires strong analytical skills, attention to detail, and a solid understanding of insurance policies and claims processes, typically supported by a relevant bachelor's degree or work experience in insurance or finance. Familiarity with claims management software (such as Guidewire or Xactimate), proficiency in Microsoft Office Suite, and knowledge of data security protocols are highly valuable, while certifications like AIC (Associate in Claims) can be advantageous. Outstanding organizational abilities, time management, strong written and verbal communication, and problem-solving skills help set top performers apart in this remote role. These competencies ensure accurate claim assessments, efficient remote collaboration, and high levels of customer satisfaction.

What are some common challenges faced by remote claims analysts, and how can they be overcome?

Remote Claims Analysts often encounter challenges such as managing a high volume of claims, communicating complex case details virtually, and staying organized without on-site supervision. To overcome these, successful analysts use robust task tracking systems, maintain proactive communication with colleagues and clients through digital channels, and regularly update their knowledge of industry practices. Time management and self-motivation are key to meeting deadlines in a remote work environment. Many employers also provide online training and resources to help analysts adapt and grow in their roles.

What is a remote claims analyst?

A Remote Claims Analyst reviews and processes insurance claims from a remote location, ensuring accuracy, compliance, and adherence to company policies. They analyze claim details, verify documentation, and determine coverage eligibility. The role may also involve communicating with policyholders, healthcare providers, or other parties to gather necessary information. Strong analytical skills and knowledge of insurance regulations are essential for success in this position.

More about Remote Claims Analyst jobs
What cities are hiring for Remote Claims Analyst jobs? Cities with the most Remote Claims Analyst job openings:
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Remote Claims Analyst jobs near you
Infographic showing various Remote Claims Analyst job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $56,974 per year, or $27.4 per hour.

Senior Claims Analyst - Hospital Bill Review

SmartLight Analytics

Plano, TX • On-site, Remote

$85K - $105K/yr

Full-time

Posted 26 days ago

Job description

We are seeking an experienced Senior Claims Analyst with deep expertise in hospital claims adjudication, stop loss reporting, high-cost/catastrophic claims, and DRG (Diagnosis-Related Group) reimbursement methodology. This individual will analyze itemized hospital bills and claims data to identify billing errors, coding discrepancies, DRG misassignments, and other overpayment opportunities, then work directly with claims administrators on behalf of our ASO clients to secure claim adjustments, recoveries, and repricing.
This is a highly analytical, client-facing role requiring both technical claims expertise and strong negotiation/communication skills.
Key Responsibilities
Claims Analysis & Review
  • Perform detailed audits of hospital and facility claims, including itemized bills, UB-04 claim forms, medical records, and remittance advices, to validate billing accuracy.
  • Analyze DRG assignments and coding to identify DRG upcoding, unbundling, duplicate billing, and other irregularities that affect reimbursement.
  • Review high-cost and catastrophic claims (typically $100K+) to identify overpayments, contract misapplication, and opportunities for negotiated adjustments.
  • Evaluate claims against plan documents, provider contracts, reference-based pricing methodologies, and CMS guidelines to determine appropriate reimbursement.
Stop Loss & High-Cost Claims Expertise
  • Understand and apply stop loss (specific and aggregate) provisions, laser terms, and reporting requirements as they relate to claim adjustments and client financial exposure.
  • Coordinate with stop loss carriers and reinsurers as needed to ensure adjustments and recoveries are properly reflected in stop loss reimbursement calculations.
  • Identify claims nearing or exceeding specific deductible thresholds and prioritize review accordingly.
Client Advocacy & Claims Administrator Negotiation
  • Serve as the subject matter expert and advocate on behalf of ASO clients in disputes with claims administrators (TPAs) and carriers regarding claim payment accuracy.
  • Prepare clear, well-documented findings packages (clinical, contractual, and coding rationale) to support requested claim adjustments and appeals.
  • Lead or support negotiations with claims administrators to reach adjusted payment resolutions.
  • Track disputes through resolution, escalating unresolved cases appropriately and maintaining strong working relationships with TPA claims and provider relations teams.
Data & Reporting
  • Analyze large claims data sets to identify trends, outlier claims, and systemic overpayment patterns across client populations.
  • Build and maintain claim tracking logs, savings reports, and client-facing summaries of identified and recovered savings.
  • Partner with internal data/analytics teams to refine claim-flagging logic and improve identification of high-value review opportunities.
Required Qualifications
  • 5+ years of experience in hospital claims analysis, medical bill review, claims auditing, or payment integrity, with direct exposure to self-funded/ASO plans.
  • Strong working knowledge of DRG methodology (MS-DRG/APR-DRG), UB-04 billing, ICD-10-CM/PCS, CPT/HCPCS coding, and hospital chargemaster structures.
  • Demonstrated understanding of stop loss insurance, including specific/aggregate deductibles, laser provisions, and how claim adjustments impact stop loss reimbursement.
  • Experience analyzing high-cost/catastrophic claims and identifying overpayment or billing error patterns.
  • Prior experience interacting with or negotiating against TPAs, insurance carriers, or claims administrators on disputed claims.
  • Proficiency with claims data analysis tools (Excel required; SQL, Access, or claims analytics platforms a plus)
  • Excellent written and verbal communication skills, with the ability to build persuasive, well-supported adjustment requests and appeals.
  • Strong attention to detail and ability to manage a high volume of complex claims simultaneously.
Preferred Qualifications
  • Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Medical Bill Review Specialist, or similar credential.
  • Prior experience at a TPA, insurance carrier, hospital billing/coding department, or payment integrity/cost containment vendor.
  • Familiarity with reference-based pricing (RBP), Medicare fee schedules, and out-of-network claims repricing.
  • Nursing background (RN) or clinical coding background is a plus for clinical validation of DRG and medical necessity issues.
What Success Looks Like
  • Consistent identification of material overpayments and billing errors on high-cost hospital claims.
  • Strong track record of securing favorable claim adjustments through negotiation with claims administrators.
  • Clear, professional communication that strengthens client trust and TPA relationships.
  • Measurable contribution to client savings and stop loss cost containment.

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