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Remote Healthcare Claims Adjudication Jobs (NOW HIRING)

MSO, INC. OF SOUTHERN CALIFORNIA

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CLAIMS MANAGER

Costa Mesa, CA · Remote

$80K - $110K/yr

Reporting directly to the CEO/President and Compliance Officer, this remote position requires ... Minimum five years medical claims adjudication experience in managed healthcare * Proficiency in ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

... healthcare claims or in a claims processing/adjudication environment. * Experience processing ... Remote work offered * Equipment provided * Paid trainingto set you up for success * Comprehensive ...

Imagenet

Claims Examiner - Remote

Tampa, FL · On-site +1

... healthcare claims or in a claims processing/adjudication environment. * Experience processing ... Remote work offered * Equipment provided * Paid training to set you up for success * Comprehensive ...

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 ...

Insperity

Director of Claims- Healthcare

Chatsworth, CA · On-site +1

$130K - $160K/yr

This position oversees all aspects of claims administration, including claims adjudication, payment ... Paid time off, flexible schedule, and remote work one day per week Plus, we work to maintain the ...

VIVA Health

Claims Training Coordinator

Birmingham, AL · Remote

Strong knowledge of medical claims adjudication processes, workflows, terminology, and benefit interpretation * Working knowledge of healthcare regulations and compliance requirements (CMS, HIPAA ...

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

This position offers flexibility for remote candidates. For candidates residing within commuting ... Experience with electronic data interchange (EDI) processes and claims adjudication platforms

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 ... and Adjudication processes. 3. Must have good experience in Reference code/data sets required in ...

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

This position offers flexibility for remote candidates. For candidates residing within commuting ... Experience with electronic data interchange (EDI) processes and claims adjudication platforms

Personify Health

Sr. Manager Healthcare Claims

$107K - $140K/yr

This position offers flexibility for remote candidates. For candidates residing within commuting ... Experience with electronic data interchange (EDI) processes and claims adjudication platforms

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Remote Healthcare Claims Adjudication information

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$45

How much do remote healthcare claims adjudication jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for remote healthcare claims adjudication in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What is a remote healthcare claims adjudicator?

A Remote Healthcare Claims Adjudicator is a professional who reviews and processes medical insurance claims from a remote location, usually working from home. They are responsible for evaluating submitted claims to determine if they comply with insurance policies and guidelines, ensuring that healthcare providers and patients receive accurate payments or denials. This involves verifying patient eligibility, reviewing medical documentation, and applying appropriate codes and regulations. Remote adjudicators must be detail-oriented, knowledgeable about medical terminology and insurance processes, and comfortable using digital systems to manage claims.

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

To thrive as a Remote Healthcare Claims Adjudicator, you need a solid understanding of medical billing, insurance policies, and claims processing, often supported by experience in healthcare administration or a relevant certification. Familiarity with claims management software, ICD/CPT coding systems, and electronic data interchange (EDI) platforms is typically required. Strong attention to detail, analytical thinking, and effective communication skills help you navigate complex cases and resolve discrepancies efficiently. These competencies are critical for ensuring accurate claims adjudication, minimizing errors, and supporting timely reimbursement in a remote work environment.

What are some common challenges faced when working remotely as a healthcare claims adjudicator, and how can they be managed?

One common challenge in remote healthcare claims adjudication is maintaining effective communication with team members and supervisors, especially when clarifying complex claims or policy guidelines. Additionally, adjudicators may find it difficult to stay updated on frequently changing regulations and payer requirements without in-person support. To overcome these challenges, it's helpful to proactively participate in virtual team meetings, utilize collaborative platforms, and regularly review updates from management. Prioritizing organizational skills and maintaining a dedicated, distraction-free workspace also supports productivity and accuracy in claim processing.
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Remote Healthcare Claims Adjudication jobs near you
Infographic showing various Remote Healthcare Claims Adjudication job openings in the United States as of August 2026, with employment types broken down into 1% Locum Tenens, 2% As Needed, 66% Full Time, 16% Part Time, and 15% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

CLAIMS MANAGER

MSO, INC. OF SOUTHERN CALIFORNIA

Costa Mesa, CA • Remote

$80K - $110K/yr

Full-time

Posted 19 days ago

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Job description

The Claims Manager at MSO, Inc. of Southern California leads the Claims Department, overseeing a small team to ensure accurate and timely adjudication of managed care claims, primarily Medicare and Medi-Cal. Reporting directly to the CEO/President and Compliance Officer, this remote position requires expertise in regulatory compliance and claims processing within a healthcare management environment. Southern California residency is preferred for occasional on-site meetings.

Responsibilities

  • Supervise and develop a small claims team of 1-5 staff
  • Ensure accurate, timely adjudication of Medicare, Medi-Cal, and Commercial claims
  • Train claims staff and support ongoing professional development
  • Prepare and submit detailed Claims Timeliness and Health Plan reports with proof of submission
  • Manage provider and Health Plan appeals and oversee payment recovery processes
  • Coordinate claims audits and corrective actions with Health Plans, auditors, and providers
  • Develop and update departmental policies, procedures, and process improvements
  • Create performance reports to monitor staff metrics and identify training needs
  • Support electronic claims submission integration, system upgrades, and auto-adjudication enhancements
  • Collaborate with Provider Services on provider, vendor, and contract data management
  • Communicate regularly with executive leadership and clients regarding claims status and issues

Required Qualifications

  • Some college coursework
  • Minimum five years medical claims adjudication experience in managed healthcare
  • Proficiency in ICD, CPT, and HCPCS coding
  • Strong knowledge of DHCS, DMHC, CMS, and Health Plan regulations for Medi-Cal, Medicare, and Commercial claims
  • Definitive understanding of provider and Health Plan contracting and reimbursement methodologies
  • Proficient Excel and computer skills
  • Strong verbal and written communication skills
  • Analytical and problem-solving abilities
  • Effective team leadership and supervisory experience

Company Description

see website www.msosocal.com