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Remote Claims Processing Jobs in New York (NOW HIRING)

Providge Consulting

Project Manager

New York, NY · Remote

Remote Job Status: Full-Time (40 hours/week) | Contract Position Summary: Our client, a leader in ... Experience with claims processing systems, workflows, and industry best practices * Successfully ...

Providge Consulting

Project Manager

New York, NY · Remote

Remote Job Status: Full-Time (40 hours/week) | Contract Position Summary: Our client, a leader in ... Experience with claims processing systems, workflows, and industry best practices * Successfully ...

Fetch Pet Insurance

Claims Adjuster

New York, NY · Remote

$20.67 - $26.44/hr

Process claims determinations to include assessment and payment for submitted claims * Verify ... Work independently in a remote capacity, while also fostering teamwork and collaborating with ...

Tmhcc

Senior Claims Examiner, Cyber

New York, NY · On-site +1

... Remote if the selected candidate does not reside near an office listed locations Job Summary ... Accurately examines and processes claims for the business unit according to existing policies and ...

CoAction

Claims Intern

Morristown, NJ · On-site +1

$15.50 - $20.50/hr

Gain a thorough understanding of the claims process through an apprenticeship with a senior claim ... Coaction's internship program does NOT offer remote work. Our internship roles are 5 days a week in ...

Liberty Mutual

Environmental Claims Officer

New York, NY · On-site +1

$94K - $197K/yr

We will also consider highly qualified remote candidates who do not reside near a hub location ... Support audit and compliance processes while maintaining required adjuster licenses and ...

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All JobsClaims Processing JobsRemote Claims Processing JobsRemote Claims Processing Jobs in New York

Remote Claims Processing information

What is remote claims processing?

Remote claims processing is the evaluation and handling of insurance claims by professionals who work from locations outside of a traditional office, often from home. These processors review claim submissions, verify information, assess coverage, and authorize payments or request additional information. Remote claims processors use secure online systems and communication tools to collaborate with colleagues and clients. This role requires strong attention to detail, confidentiality, and proficiency with digital platforms. Many insurance companies now offer remote claims processing positions to increase flexibility and efficiency.

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

To thrive as a Remote Claims Processor, you need a strong understanding of insurance policies, attention to detail, and relevant experience or education in insurance or finance. Familiarity with claims management software, electronic document systems, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent communication, time management, and problem-solving abilities help you stand out, especially when working independently. These skills ensure accurate, timely claims resolutions and effective collaboration with clients and colleagues in a remote environment.

What are some common challenges faced in remote claims processing roles, and how can they be effectively managed?

Remote claims processing professionals often encounter challenges such as managing high volumes of claims, maintaining clear communication with team members, and ensuring data security while working from home. Effective time management and strong organizational skills are key to handling large workloads efficiently. Regular check-ins with supervisors and using secure, company-approved communication tools can help maintain collaboration and protect sensitive information. Many organizations also provide training and support to help remote processors stay up-to-date with changing regulations and best practices.

What is the difference between Remote Claims Processing vs Remote Claims Adjuster?

AspectRemote Claims ProcessingRemote Claims Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires insurance licenses and adjuster certifications
Work EnvironmentHome-based, administrative settingHome-based or field, investigative and evaluative tasks
Industry UsageInsurance companies, third-party administratorsInsurance companies, public adjusting firms
Job FocusProcessing claims, data entry, customer serviceInvestigating claims, assessing damages, settlement negotiations

Remote Claims Processing and Remote Claims Adjuster roles share similarities in industry and work environment but differ in job focus and required credentials. Claims processors handle administrative tasks and data entry, while claims adjusters evaluate damages and negotiate settlements. Both roles are essential in the insurance industry and often require specialized certifications.

What are the most commonly searched types of Claims Processing jobs in New York?

The most popular types of Claims Processing jobs in New York are:

What are popular job titles related to Remote Claims Processing jobs in New York?

For Remote Claims Processing jobs in New York, the most frequently searched job titles are:

What job categories do people searching Remote Claims Processing jobs in New York look for?

The top searched job categories for Remote Claims Processing jobs in New York are:

What cities in New York are hiring for Remote Claims Processing jobs?

Cities in New York with the most Remote Claims Processing job openings:

Remote Claims Processing jobs near you
Infographic showing various Remote Claims Processing job openings in New York as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 16% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution.

Senior Specialist, Pharmacy Systems Operations - Remote

EmblemHealth

New York, NY • On-site, Remote

$68K - $118K/yr

Full-time

Re-posted 28 days ago

EmblemHealth rating

9.4

Company rating: 9.4 out of 10

Based on 7 frontline employees who took The Breakroom Quiz

14th of 311 rated insurance

Job description

Summary of Job
Serve as pharmacy systems coding subject matter expert for Prior Authorization with a focus on medical drug claim processing, review of utilization management, PA processing, and appeals; as well as the following: claims processes and JUDI interoperability with FACETS edits and other connection troubleshooting. Provide technical and subject matter expertise support for implementations and day to day operations of Pharmacy functions and vendor coordination. Support operations for file transfer systems (configuration, deployment, pharmacy management and medical benefits, eligibility). Support operations for system integration, including monitoring files and transitions, fallout, and root cause analyses. Execute non-clinical Appeals from post claim edit process, and consistently maintain queue
Responsibilities
  • Collaborate in defining, gathering, reviewing, and editing business requirements for system updates, enhancements and migrations for claims projects.
  • Perform solution analysis review and provide concise direction to ensure that the proposed system solution meets established business protocols, and any mandates and compliance guidelines.
  • Partner with business analysts, business users and source system experts to produce claim processing output consistent with meeting overall goals.
  • Review daily, pended medical drug claims for accuracy.
  • Identify and implement solutions to support automation of claims or resolve with manual intervention.
  • Collaborate with clinical, formulary, payment integrity and other key players to ensure issues are accurately defined with an appropriate solution.
  • Submit and track medical claims system configuration requests related to RPC (Reimbursement Policy Committee) decisions, ensuring timely implementation and alignment with approved policy guidelines.
  • Work with business units to develop test strategies and scenarios from business requirements.
  • Accurately interpret and translate strategies and scenarios into test plans.
  • Analyze requirements, test documents and acceptance criteria which will effectively find defects that may exist in claims processing.
  • Act as a liaison and subject matter expert for day to day medical drug system-related technical questions and/or issues.
  • Troubleshoot and track all concerns on unpaid claims, working with key stakeholders and respond to all appropriate parties effectively within a timely manner.
  • Provide written progress report to leadership regarding the status of deliverables, issues, problems and corrective actions taken.
  • Perform other related tasks as directed or required

Qualifications
  • Bachelor's degree required
  • 4 - 6+ years of relevant, professional work experience (Required)
  • 2+ years' experience in one or more of the following: claims processing, pharmacy/coding, utilization management (Required)
  • Experience in a healthcare environment (Required)
  • Proficiency with MS Office - Word, Excel, Access, PowerPoint, Outlook (Required)
  • Advanced reporting system experience/knowledge - SAS, Oracle, etc. (Preferred)
  • Track record of successfully managing multiple tasks/projects with competing priority levels/deadlines (Required)
  • Ability to understand complex technical system requirements and translate into simple business language (Required)
  • Excellent communication skills - verbal, written, presentation, reporting, interpersonal (Required)
  • Attention to detail; ability to think critically; ability to identify, quantify, analyze and resolve issues (Required)

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