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Remote Healthcare Claims Adjudication Jobs (NOW HIRING)

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD, or VA per client) About the Role We're hiring a Healthcare Claims Adjuster with a strong claims ...

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD, or VA per client) About the Role We're hiring a Healthcare Claims Adjuster with a strong claims ...

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD, or VA per client) About the Role We're hiring a Healthcare Claims Adjuster with a strong claims ...

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD, or VA per client) About the Role We're hiring a Healthcare Claims Adjuster with a strong claims ...

System One

Healthcare Claims Adjuster

Baltimore, MD · Remote

$25/hr

Contract To Hire Compensation : $25/HR Contractor Work Model : 80% Remote (must reside in D.C., MD, or VA per client) About the Role We're hiring a Healthcare Claims Adjuster with a strong claims ...

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Remote Healthcare Claims Adjudication information

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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.

Business Analyst (Policy remediation) - Contract - Remote

SUNSHINE ENTERPRISE USA LLC

Columbia, SC • Remote

Contractor

Re-posted 8 days ago

Job description

Business Analyst (Policy remediation) Location: Remote Interview Process: 1 round, virtual Duration: 12 Months Employment Type: Contract Experience Required: 05+ Years Candidate Location: Candidate MUST be a SC resident. No relocation allowed. Project Scope: We are seeking an experienced Business Analyst with expertise in policy remediation, medical coding, and healthcare claims systems.

This role will serve as a subject matter expert (SME) supporting policy and operational initiatives related to medical coding compliance, claims adjudication, and system change management. The ideal candidate will leverage deep knowledge of ICD-10, CPT, and HCPCS coding methodologies, as well as Medicaid and payer operations, to ensure alignment between policy updates, coding changes, and system functionality. This position will play a critical role in supporting compliance initiatives, regulatory updates, and business process improvements.

Key Responsibilities: Serve as a subject matter expert (SME) for medical coding methodologies, Medicaid policy, and claims adjudication processes. Analyze annual, quarterly, and ad hoc coding updates, including ICD-10, CPT, and HCPCS changes. Review and assess the impact of coding and policy changes on business processes, system functionality, and claims outcomes.

Collaborate with business stakeholders, policy teams, and technical teams to define requirements and implement necessary system changes. Support change requests and ensure system updates produce accurate and expected claims adjudication results. Research business rules, requirements, and process models to develop recommendations and solutions.

Maintain and update business rules, requirements documentation, and process models in designated repositories. Lead meetings with stakeholders, business owners, and cross-functional teams. Participate in policy remediation efforts, compliance initiatives, and related enterprise projects.

Ensure process documentation, training materials, and supporting documentation are complete and up to date. Collaborate with internal teams to support ongoing operational and regulatory compliance. Provide expertise in medical coding software, claims systems, and healthcare policy interpretation.

Required Skills & Experience: Minimum of 5 years of experience in healthcare insurance, medical review, program integrity, or appeals. At least 5 years of experience working with IT developers and programmers in a payer environment. Minimum of 5 years of hands-on experience in medical coding within a payer environment.

Strong expertise in ICD-10, CPT, and HCPCS coding methodologies and translation. Minimum of 5 years of experience with medical claims processing systems. Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint).

Experience using Optum Encoder or similar medical coding software. Strong analytical, problem-solving, and critical-thinking skills. Excellent written and verbal communication skills.

Preferred Skills: Minimum of 5 years of experience in policy remediation. At least 3 years of clinical experience in a healthcare environment. Strong clinical assessment and critical-thinking skills.

Experience with Medicaid programs and Medicaid Management Information Systems (MMIS). Familiarity with healthcare regulatory compliance and policy implementation. Technical Skills Medical Coding and Reimbursement, ICD-10, CPT, and HCPCS Expertise, Policy Remediation and Compliance, Claims Adjudication and Processing, Medicaid and MMIS Knowledge, Business Requirements Analysis, Process Documentation and Improvement, Stakeholder Engagement and Facilitation, Regulatory and Operational Compliance, Cross-Functional Collaboration Education: Bachelor's degree in Health Information Management, Healthcare Administration, Business, or a related field.

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