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Remote Claims Examiner Jobs in Remote, OR (NOW HIRING)

Primus Software Corporation

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Claims QA/BA (Healthcare- Contract to hire)

OR · Remote

$45 - $68/hr

Remote Description: Responsible for claims testing for health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops ...

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Remote Claims Examiner information

See Remote, OR salary details

$15

$29

$45

How much do remote claims examiner jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for remote claims examiner in Remote, OR is $29.37, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.05 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a remote claims examiner, and why are they important?

To thrive as a Remote Claims Examiner, you need a solid understanding of insurance policies, analytical skills, and attention to detail, typically supported by a degree in business or a related field and relevant claims experience. Familiarity with claims management software, document management systems, and sometimes certifications like AIC (Associate in Claims) are often required. Strong communication, time management, and problem-solving abilities help you effectively assess claims and collaborate remotely. These skills are crucial for accurate, efficient claims processing and maintaining trust with clients and insurers in a remote environment.

What are some common challenges remote claims examiners face, and how can they overcome them?

Remote Claims Examiners often encounter challenges such as maintaining clear communication with team members and accessing required documentation efficiently. Since the role is remote, staying organized and disciplined is essential to meet deadlines and manage caseloads effectively. Utilizing secure digital platforms, setting regular check-in meetings, and proactively seeking clarification on complex claims can help overcome these challenges. Additionally, embracing ongoing training on claims software and staying updated with industry regulations ensures accurate and timely claim processing.

What does a remote claims examiner do?

Remote claims examiners review insurance claims to ensure they are accurate and completed properly. Instead of working in the office, remote claims examiners work from home or another location outside of the office. As a remote claims examiner, your job duties include researching the claim and gathering supportive documentation, such as medical records, invoices with services rendered, and policy guidelines. Once you have all the necessary information, you may make adjustments to the claim and determine payments or denial of service. You may also be responsible for contacting all parties involved. Complicated claims may require collaboration with a claims adjuster or investigator. Claims examiners work in healthcare, real estate, automotive, government agencies, and other insurance-related industries.

What is a remote claims examiner?

A Remote Claims Examiner is a professional who reviews insurance claims from home or another remote location. Their primary job is to investigate, evaluate, and process claims to determine their validity and the amount that should be paid out. They work for insurance companies, healthcare providers, or third-party administrators, handling documentation, communicating with claimants, and ensuring compliance with regulations. By working remotely, they use digital tools to manage claims and collaborate with other team members online.
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Claims QA/BA (Healthcare- Contract to hire)

Primus Software Corporation

OR • Remote

$45 - $68/hr

Full-time

Posted 4 days ago

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Job description

Job description

Job Title: Healthcare Claims EDI BA/QA

Duration: 06 Months (Contract to Hire) – W2 Only

Location: Remote


Description:

Responsible for claims testing for health care projects. Drive the test strategy and process, domain knowledge, perform analysis of business requirements, designs and develops test plans, ensures quality process, coordinates with customers on delivery and deployments. Works in team environment and provides testing guidance throughout the entire life cycle. Responsible to meet customer expectations, troubleshoot problems in the application and assisting customers in implementation decisions.

1.            Candidate should have strong health care domain experience and should have good knowledge of Medicaid and Medicare.

2.            Candidate should have hands-on experience on claims processing and Adjudication processes.

3.            Must have good experience in Reference code/data sets required in Claims adjudication.

4.            Must have prior experience or understanding in configuring benefits or programs in claims system across various sub-systems.

5.            Should be able to run queries and perform basic system analysis, RCA etc.,

6.            Should work closely with the client and development team during the stages of development, and conduct demos at completion of milestone, track and close feedback from such demos

7.            Must have excellent written and spoken communication skills. Should be able to multitask between internal team and clients based on priority tasks

8.            Work Closely with Dev, architecture and Design teams to define the GUI view and platform requirements, which is the foundation of the product.

9.            In depth understanding of Claims and Claims lifecycle     

10.         Claim Types

11.         Claim Formats:

-              EDI X12 formats like 837P/I/D

-              X12 formats 835, 834, 270/271, 276/277

12.         Claim System:

-              Familiarity with systems like CMdS, GHS, Facets and etc

Testing knowledge and E2E Testing

Company Description

Primus Software Corporation. Primus Software Corporation is a global staff augmentation firm providing a wide-range of talent on-demand and total workforce solutions. We have excellent domain expertise in all verticals. We provide long term solutions with quality as our main focus. To learn more about Primus Software Corporation, please visit our website www.primussoftcom. I recently came across your resume on job boards, and I wanted to reach out to you regarding an exciting job opportunity that I believe aligns perfectly with your skills and experience.