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Remote Claims Resolution Specialist Jobs (NOW HIRING)

Onco360

$23/hr

This is a remote hybrid opportunity, after onsite training period. Shift time between 8am and 8pm ... Practices first call resolution to help health care providers and patients with their pharmacy ...

TRILLIUM HEALTH RESOURCES

Claims Specialist II

NC · Remote

$42K - $61K/yr

Remote within North Carolina POSTING DETAILS: Make an Impact Trillium Health Resources is a ... resolution. On a typical day, you might: * Analyze and audit claims adjudication results to ...

Aflac Incorporated

Sr Consult, Claims Resolution

Windsor, CT · Remote

$110K - $150K/yr

If the role is remote, there may be occasions that you are requested to come to the office based on ... Strong understanding of claims processes and compliance. Or an equivalent combination of education ...

NTT DATA Services

Claims Examiner Remote

Plano, TX · On-site +1

... and resolution of claims received via emails as priority work • Correctly calculate claims ... While many positions offer remote or hybrid work options, these arrangements are subject to change ...

ARC Group

Claims Adjustor (BI)

Oakland Park, FL · Remote

CLAIMS ADJUSTER (remote) ARC Group seeks two Bodily Injury Claims Adjuster to work in a remote ... claims specialists, to facilitate efficient claims resolution. Documentation and Reporting:

NTT DATA Services

Claims Examiner Remote

Plano, TX · On-site +1

... and resolution of claims received via emails as priority work • Correctly calculate claims ... While many positions offer remote or hybrid work options, these arrangements are subject to change ...

NTT DATA Services

Claims Examiner Remote

Plano, TX · On-site +1

Timely response and resolution of claims received via emails as priority work Correctly calculate ... While many positions offer remote or hybrid work options, these arrangements are subject to change ...

RemX

Be Seen First

$19/Hr. REMOTE - Medical Billing Specialist *APPLY NOW* (Dallas Area)

Fort Worth, TX · Remote

$19/hr

... Claims Specialists to join our growing healthcare operations team. This is a fully remote ... claims processing, insurance follow-up, claims resolution, and revenue cycle functions for a ...

GIA Legacy Planning

$1.6K - $1.9K/wk

Mortgage Protection Resolution Specialist Location ... Remote Position/Work from Home Job Type: Full-Time/Part-Time Compensation: Uncapped Commission ...

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Remote Claims Resolution Specialist information

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$12

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How much do remote claims resolution specialist jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for remote claims resolution specialist in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What is a remote claims resolution specialist?

A Remote Claims Resolution Specialist is responsible for reviewing, analyzing, and resolving insurance claims from a remote location. They work with policyholders, providers, and internal teams to investigate claim issues, ensure accuracy, and facilitate timely payments or denials. This role requires strong attention to detail, problem-solving skills, and knowledge of insurance policies and regulations. Effective communication and the ability to work independently are essential for success in this position.

What are the typical daily responsibilities of a remote claims resolution specialist?

As a Remote Claims Resolution Specialist, your daily tasks typically include reviewing and processing insurance claims, analyzing documentation, communicating with policyholders and adjusters, and investigating discrepancies or additional information needs. You'll spend much of your time resolving issues via phone, email, or chat, ensuring claims are handled efficiently and in compliance with company policies. Collaboration with other team members and departments is common, especially when complex or escalated cases arise. Staying organized and proactive is key to managing multiple cases and meeting deadlines in a remote work environment.

What are the key skills and qualifications needed to thrive in the remote claims resolution specialist position, and why are they important?

To succeed as a Remote Claims Resolution Specialist, you should have strong analytical and problem-solving abilities, knowledge of insurance policies, and relevant experience in claims processing or customer service. Familiarity with claims management software, CRM systems, and proficiency in digital communication tools are typically required, and some employers may prefer certification such as AIC (Associate in Claims). Excellent written communication, attention to detail, and the ability to manage time effectively set outstanding candidates apart. These skills are essential to ensure accurate, timely resolutions, maintain customer satisfaction, and uphold the integrity of the claims process in a remote setting.

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Remote Claims Resolution Specialist jobs near you
Infographic showing various Remote Claims Resolution Specialist job openings in the United States as of August 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Remote

$23/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

20th of 113 rated pharmacies

Job description

W e are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy in Scottsdale, AZ. This will be a Full-Time position. This is a remote hybrid opportunity, after onsite training period.
Shift time between 8am and 8pm.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Starting salary from $23.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits - life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documents and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills
#Company Values: Teamwork, Respect, Integrity, Passion
#IH Employment Type: Full Time

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