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Remote Claims Representative Jobs (NOW HIRING)

Berkley

Claims Representative

Manassas, VA · Remote

$65K - $75K/yr

Amazingly Easy." Responsibilities As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers' compensation ...

Berkley

Claims Representative

Manassas, VA · Remote

$65K - $75K/yr

Amazingly Easy." As a Claims Representative, you will be responsible for the investigation, evaluation, mitigation and resolution of medical only and lost time workers' compensation claims of ...

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$42

How much do remote claims representative jobs pay per hour?

As of Jul 18, 2026, the average hourly pay for remote claims representative in the United States is $24.12, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $27.40 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Remote Claims Representative position, and why are they important?

To thrive as a Remote Claims Representative, you need strong analytical abilities, attention to detail, and a solid understanding of insurance policies and claim processes, often supported by a relevant associate's or bachelor's degree. Familiarity with claims management software, CRM systems, and occasionally industry certifications like AIC (Associate in Claims) is highly beneficial. Excellent communication, problem-solving skills, and the ability to work independently are important soft skills for success in this remote role. These competencies ensure accurate evaluation and efficient resolution of claims while maintaining high customer satisfaction and adherence to regulatory standards.

What is a Remote Claims Representative job?

A Remote Claims Representative is responsible for reviewing, processing, and resolving insurance claims while working from a remote location. They assess claim details, verify coverage, and communicate with policyholders, medical providers, or other relevant parties to ensure accurate and timely claim settlements. Strong analytical skills, attention to detail, and knowledge of insurance policies are essential for this role. The job often involves using digital tools to document claims and provide customer support.

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

Remote Claims Representatives often encounter challenges such as managing high caseloads, communicating complex decisions effectively with clients, and staying organized without direct in-person supervision. Successfully navigating these challenges typically involves developing strong time management, self-motivation, and clear digital communication skills. Many companies provide robust training, digital collaboration tools, and regular virtual meetings to support remote staff and maintain team cohesion. Proactively seeking feedback and utilizing available resources can help you stay on track and excel in this dynamic remote environment.

More about Remote Claims Representative jobs
What cities are hiring for Remote Claims Representative jobs? Cities with the most Remote Claims Representative job openings:
What are the most commonly searched types of Claims Representative jobs? The most popular types of Claims Representative jobs are:
What states have the most Remote Claims Representative jobs? States with the most job openings for Remote Claims Representative jobs include:
What job categories do people searching Remote Claims Representative jobs look for? The top searched job categories for Remote Claims Representative jobs are:
Remote Claims Representative jobs near you
Infographic showing various Remote Claims Representative job openings in the United States as of July 2026, with employment types broken down into 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $50,180 per year, or $24.1 per hour.
Senior Claims Representative (Remote)

Senior Claims Representative (Remote)

Missouri Employers Mutual Insurance

Remote

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Job description

Senior Claims Representative

Are you a seasoned claims professional with a passion for navigating complex cases? MEM Insurance is seeking a Senior Claims Representative to join our Claims team. In this pivotal role, you'll manage high-exposure workers' compensation claims, lead investigations into coverage and fraud, and collaborate across departments to drive strategic outcomes. You'll be a key decision-maker, a mentor to junior adjusters, and a champion of process improvement—all while ensuring exceptional service and regulatory compliance.

At MEM Insurance, we don't just protect our customers—we empower our employees. We foster a culture of integrity, collaboration, and innovation. Our team thrives on solving challenges together, supporting one another, and making a meaningful impact in the lives of our policyholders and injured workers.

Essential Duties and Responsibilities
  • Manage highly complex claims involving significant financial exposure, legal intricacies, and extended life cycles.
  • Conduct advanced investigations into coverage and compensability, including nuanced statutory interpretations.
  • Oversee medical case management for catastrophic injuries and lifetime care needs.
  • Review and authorize large or complex medical bills, negotiating adjustments to control costs.
Return-to-Work Management
  • Develop comprehensive RTW strategies in collaboration with policyholders, legal counsel, and vocational consultants.
  • Ensure precision in benefit calculations for high-exposure claims, addressing tax and compliance risks.
  • Strategically deploy investigative efforts aligned with broader claims strategy.
Claims Investigation & Loss Prevention
  • Lead investigations into complex fraud cases and collaborate with the Special Investigations Unit.
  • Conduct subrogation analysis and negotiate with third-party insurers or attorneys for maximum recovery.
Settlements & Negotiation
  • Partner with legal teams to negotiate complex settlements and manage litigation processes.
  • Oversee Medicare compliance initiatives, including Medicare Set-Asides and CMS engagement.
  • Identify opportunities for structured settlements and lead negotiations.
Reporting
  • Produce strategic reports on high-profile claims to guide management decisions.
  • Maintain system data integrity and prepare claims for Corporate Plan of Action meetings.
Collaboration
  • Lead cross-departmental efforts to improve claims handling and risk management.
  • Resolve escalated customer service issues and support high-value accounts.
  • Participate in workflow improvement initiatives and committees.
Team Leadership
  • Mentor and coach junior and intermediate adjusters.
  • Review escalated claims and provide actionable feedback.
  • Support workforce development and succession planning.
Qualifications:
  • Bachelor's degree in business or related field preferred, or equivalent industry experience.
  • 7–10 years of claims handling experience, with high exposure to Workers' Compensation.
  • Associate in Claims (AIC), AIM, or CPCU designation preferred or ability to obtain.
  • Texas All-Lines license preferred.
  • Valid driver's license required.
Company Culture and Values

At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other's growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered.

Connection and Belonging

MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities.

Total Rewards Overview
  • Health Plans: Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia.
  • Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability.
  • Wellness and Recognition Program: Employer-paid incentives for employees and spouses.
  • Flexible Spending Account and Dependent Care options
  • Health Savings Account: Generous employer contribution.
  • Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave.
  • Employee Assistance Programs
  • 401k Retirement Plan: Employer match and profit sharing.
  • Adoption Assistance and Tuition Assistance

Notice Regarding Use of Artificial Intelligence MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.

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