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Remote Claims Processor Jobs in Sumter, SC (NOW HIRING)

Chubb

Bilingual Contact Center Representative

Columbia, SC · On-site +1

$31K/yr

... Claims issues. * Assist clients by matching our products with the needs to the client. * Assist in ... Understands organizational objectives, supports process improvements, and provides feedback to ...

SixAxis LLC

Customer Service Representative

Sumter, SC · On-site +1

$14 - $19.25/hr

Processes entries, prepares and files commercial documentation and assists with calculations/report preparation as needed. This position is located at our Sumter, SC location. Key Responsibilities:

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Remote Claims Processor information

See Sumter, SC salary details

$10

$17

$23

How much do remote claims processor jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for remote claims processor in Sumter, SC is $17.07, according to ZipRecruiter salary data. Most workers in this role earn between $14.57 and $18.41 per hour, depending on experience, location, and employer.

What are some common challenges faced by Remote Claims Processors, and how can they be addressed?

Remote Claims Processors often encounter challenges such as managing high volumes of claims, maintaining accuracy without in-person supervision, and communicating effectively with team members across different locations. To address these, it's essential to develop strong organizational skills, utilize digital tools for tracking and documentation, and participate actively in virtual team meetings. Proactively seeking feedback and staying updated on policy changes can also enhance efficiency and reduce errors in a remote setting.

What Does a Remote Claims Processor Do?

The job duties of a remote claims processor revolve around working to process insurance claims. You typically work from home or another remote location. Your responsibilities start with assessing the claimant's insurance policy and coverage. You review documents and records related to the claim and decide on approval or denial of the claim. A processor also prepares the paperwork necessary for the insurer to process the case for the client. You also have customer service duties, such as answering patient questions and telling them about the claim status. Processors can work with medical insurance, property insurance, or casualty insurance.

What does a Remote Claims Processor do?

A Remote Claims Processor reviews, evaluates, and processes insurance claims from a remote location, typically working from home. They verify information, assess documentation, and determine the validity of claims for insurance companies or healthcare providers. This role requires attention to detail, knowledge of insurance policies, and the ability to communicate with clients or providers to resolve discrepancies. Remote Claims Processors use specialized software to manage claims efficiently and ensure compliance with industry regulations.

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

To thrive as a Remote Claims Processor, you need strong attention to detail, analytical skills, and a solid understanding of insurance policies, often supported by a high school diploma or relevant experience. Familiarity with claims management software, Microsoft Office Suite, and sometimes industry certifications like AIC (Associate in Claims) are typically required. Excellent written communication, time management, and problem-solving abilities help you stand out in this role. These skills ensure accurate and efficient claims handling, customer satisfaction, and compliance with regulatory standards in a remote work environment.

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

AspectRemote Claims ProcessorRemote Claims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may require insurance or claims processing certificationsHigh school diploma or equivalent; often requires licensing or certification in insurance claims examination
Work EnvironmentHome-based or remote office; primarily computer and phone workHome-based or remote; involves reviewing and analyzing insurance claims
Industry UsageInsurance, healthcare, government agenciesInsurance companies, healthcare providers, government agencies
Common Search/ComparisonYesYes

Remote Claims Processors and Remote Claims Examiners both work in the insurance industry, often remotely, handling claims. While both roles require similar credentials and work environments, Claims Examiners typically perform more detailed analysis and may require specific licensing. Understanding these differences helps job seekers identify the right position based on their skills and certifications.

More about Remote Claims Processor jobs
What job categories do people searching Remote Claims Processor jobs in Sumter, SC look for? The top searched job categories for Remote Claims Processor jobs in Sumter, SC are:
What cities near Sumter, SC are hiring for Remote Claims Processor jobs? Cities near Sumter, SC with the most Remote Claims Processor job openings:
Remote Claims Processor jobs near you
Business Analyst - Clinical Analyst & Coding Specialist - Contract - Remote

Business Analyst - Clinical Analyst & Coding Specialist - Contract - Remote

SUNSHINE ENTERPRISE USA LLC

Columbia, SC • Remote

Contractor

Re-posted 26 days ago

Job description

Business Analyst - Clinical Analyst & Coding Specialist Location: Fully Remote Interview Process: 1 round, Virtual/Online Duration: 12 Months Employment Type: Contract Experience Required: 08+ Years Candidate Location: Candidate MUST be a SC resident. No relocation allowed. Project Scope: We are seeking an experienced Business Analyst - Clinical Analyst & Coding Specialist to support Medicaid policy, coding analysis, claims processing, and MMIS initiatives for a large healthcare and government environment.

This role will serve as a subject matter expert (SME) supporting medical coding compliance, coding updates, policy remediation, and Medicaid business process improvements. The ideal candidate will have strong experience in medical coding, healthcare insurance operations, Medicaid claims processing, and payer systems, along with a clinical background and the ability to collaborate with both technical and business teams. This role will also contribute to future MMIS modernization and replacement initiatives.

Key Responsibilities: Serve as a subject matter expert (SME) for medical coding methodologies, Medicaid policy, and healthcare claims processing. Support annual, quarterly, and ad hoc ICD-10, CPT, and HCPCS coding updates received from CMS. Perform analysis of medical coding changes and assess impact on business processes, claims adjudication, and system functionality.

Conduct initial code reviews and determine the scope and business impact of coding updates. Prepare and distribute coding change listings for review by Medicaid program teams and reference administration staff. Collaborate with policy owners, stakeholders, developers, and business teams to support change requests and MMIS enhancements.

Participate in MMIS modernization and replacement project meetings, providing coding and business process expertise. Research business rules, operational requirements, and process models to develop recommendations and solutions. Maintain business rules, coding documentation, requirements repositories, and process documentation.

Facilitate meetings with agency personnel, stakeholders, and operational teams. Support policy remediation efforts and ensure alignment between coding standards and operational workflows. Assist with development and maintenance of training documentation and process materials.

May review patient records against established medical necessity criteria as backup support. Work collaboratively with cross-functional teams supporting Medicaid operations and healthcare initiatives. Required Skills & Experience: 5+ years of experience in healthcare insurance, medical review, program integrity, or appeals 5+ years of experience working with IT developers/programmers in a payer environment 5+ years of hands-on medical coding experience in a payer environment 5+ years of Strong expertise in ICD-10, CPT, and HCPCS coding methodologies and translation 5+ years of Strong understanding of anatomy, physiology, pharmacology, and medical terminology 3+ years clinical experience in a healthcare environment (strong clinical assessment and critical thinking skills.) Experience supporting Medicaid operations and MMIS systems Strong analytical, documentation, and business requirements gathering skills Excellent written and verbal communication skills Proficiency with Microsoft Office Suite Preferred Skills: 5+ years of experience in policy remediation 5+ years of experience with claims processing systems 5+ years of Experience using: Optum Encoder, Other medical coding software platforms 3+ years of clinical experience in a healthcare environment Strong clinical assessment and critical-thinking skills Experience supporting government healthcare or managed care operations License Must have current, active, and non-restricted licensure by the State of South Carolina Board of Nursing as a Registered Nurse

Certification Currently credentialed as CPC (Certified Professional Coder) or as CCS (Certified Coding Specialist). ICD-10 Proficiency demonstrated by exam; or able to become certified within one year of employment. Education: Bachelor of Science in Nursing (BSN) OR Associate Degree in Nursing (ADN).

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