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Remote Medical Claims Examiner Jobs in Riverside, CA

Corvel

Medical Only Claims Specialist

Rancho Cucamonga, CA · Remote

$16.74 - $26.92/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives Workers' Compensation ... claims practice, relevant statutes, and medical terminology * Ability to identify, analyze and ...

Corvel

Senior Claims Specialist (SIP) 4850

Rancho Cucamonga, CA · Remote

$29.35 - $47.28/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This is a remote position. Candidates must reside in California. ESSENTIAL FUNCTIONS ... A comprehensive benefits package is available for full-time regular employees and includes Medical ...

Inspire Healthcare

Medical Director job in Pomona CA

Pomona, CA · Remote

$250K - $350K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and ... Participate in appeals, grievance reviews, retrospective claims reviews, and quality improvement ...

Inspire Healthcare

Internal Medicine job in Pomona CA

Pomona, CA · Remote

$250K - $350K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and ... Participate in appeals, grievance reviews, retrospective claims reviews, and quality improvement ...

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All JobsMedical Claims Examiner JobsRemote Medical Claims Examiner JobsRemote Medical Claims Examiner Jobs in Riverside, CA

Remote Medical Claims Examiner information

See Riverside, CA salary details

$16

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$47

How much do remote medical claims examiner jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for remote medical claims examiner in Riverside, CA is $30.67, according to ZipRecruiter salary data. Most workers in this role earn between $23.32 and $36.63 per hour, depending on experience, location, and employer.

How does working remotely as a medical claims examiner impact collaboration with healthcare providers and internal teams?

Working remotely as a Medical Claims Examiner often relies heavily on digital communication tools to collaborate with healthcare providers, billing departments, and internal claims teams. While you may not have face-to-face contact, regular virtual meetings, emails, and secure messaging platforms are used to clarify claim details, resolve discrepancies, and ensure timely processing. Successful remote examiners are proactive communicators and often participate in team huddles or check-ins to stay aligned on policies and workflow updates. Building strong virtual relationships is key to overcoming the challenge of not being onsite, and most organizations provide training and support for effective remote collaboration.

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

AspectRemote Medical Claims ExaminerRemote Medical Claims Processor
Required CredentialsMedical background, certifications like CPC or CCSBasic insurance knowledge, often no medical credentials needed
Work EnvironmentHome-based, insurance companies, healthcare providersHome-based, insurance companies, healthcare providers
Job FocusReviewing medical claims for accuracy and coverageProcessing claims, data entry, and initial review
Common UsageUsed in insurance and healthcare industriesUsed in insurance companies and claims departments

The main difference is that Remote Medical Claims Examiners review and evaluate medical claims for accuracy and coverage, often requiring medical credentials. In contrast, Remote Medical Claims Processors handle the initial processing and data entry of claims, typically without medical certifications. Both roles are remote and serve the insurance industry, but the Claims Examiner role involves more specialized medical review.

What are the key skills and qualifications needed to thrive as a remote medical claims examiner?

To thrive as a Remote Medical Claims Examiner, you need a strong understanding of medical terminology, healthcare regulations, and claims processing, often supported by a degree in health administration or a related field. Familiarity with claims management systems, insurance software, and relevant certifications such as Certified Professional Coder (CPC) are highly beneficial. Attention to detail, analytical thinking, and effective communication are essential soft skills for ensuring accuracy and resolving discrepancies. These skills and qualifications are crucial for minimizing errors, preventing fraud, and ensuring timely and compliant claim adjudication in a remote work environment.

What does a remote medical claims examiner do?

As a remote medical claims examiner, your primary responsibilities involve investigating health insurance claims. In this career, you work from home and assess patient insurance coverage information and eligibility. You speak with patients, doctors, and other involved parties to gain additional insight into each case. Your duties include taking steps to review each case and decide whether to pay the claim, negotiate a settlement, or deny the request. You make these decisions based on the data you collect and the policy of your employer. You also take steps to detect and defend against fraud.

What does a remote medical claims examiner do?

A Remote Medical Claims Examiner is responsible for reviewing and processing medical insurance claims from a remote location, often working from home. Their job involves evaluating medical records, verifying patient eligibility, checking the accuracy of billing codes, and determining whether claims should be approved, denied, or sent back for more information. They ensure that claims comply with insurance policies and regulatory guidelines, and may also communicate with healthcare providers or policyholders to clarify details. Working remotely requires strong attention to detail, good communication skills, and proficiency with specialized claims processing software.
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The top searched job categories for Remote Medical Claims Examiner jobs in Riverside, CA are:

What cities near Riverside, CA are hiring for Remote Medical Claims Examiner jobs?

Cities near Riverside, CA with the most Remote Medical Claims Examiner job openings:

Remote Medical Claims Examiner jobs near you
Infographic showing various Remote Medical Claims Examiner job openings in Riverside, CA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% Remote job distribution, with an average salary of $63,802 per year, or $30.7 per hour.

Workers Compensation Claims Examiner

TEEMA Group

Chino, CA • Remote

$93K - $104K/yr

Full-time

Re-posted 25 days ago

Job description


Claims Examiner (Workers’ Compensation)

Position Summary

Our client is seeking an experienced Claims Examiner to independently manage a full-cycle caseload of workers’ compensation claim from inception through resolution. This role requires strong technical expertise, sound judgment, and the ability to handle highly complex indemnity claims within established authority limits.

This is a highly interactive role requiring regular communication with clients, claimants, attorneys, medical providers, and internal stakeholders. Consistent, reliable attendance and strong organizational discipline are essential to success.

Key Responsibilities

  • Manage a caseload of 150–180 workers’ compensation claims, including complex indemnity cases

  • Conduct timely and thorough investigations to determine claim compensability

  • Administer benefits in accordance with state regulations and company guidelines

  • Oversee medical treatment plans and authorize medical services and billing as appropriate

  • Coordinate with and manage defense counsel on litigated claims

  • Communicate effectively with claimants, providers, vendors, and clients regarding claim status and issues

  • Establish and maintain appropriate claim reserves within authority guidelines

  • Negotiate and finalize claim settlements within designated authority levels

  • Maintain accurate and up-to-date claim documentation and diary systems

  • Provide clients with timely updates, including injury trends and risk insights

  • Conduct independent file reviews and ensure compliance with internal policies

  • Perform additional duties as assigned

Qualifications

Education & Experience

  • Bachelor’s degree in a related field (preferred)

  • 5+ years of workers’ compensation claims experience or equivalent combination of education and experience
    Must have an active California SIP certification - Self Insurance Plans)

Knowledge, Skills & Abilities

  • Strong knowledge of workers’ compensation laws and regulations

  • Familiarity with medical terminology and claims processes

  • Excellent analytical and problem-solving skills

  • Strong written and verbal communication skills

  • Ability to manage high-volume, complex caseloads independently

  • Proficiency in Microsoft Office (Word, Excel preferred)

  • Ability to collaborate effectively with stakeholders at all levels

Certifications

  • Relevant state licenses and/or certifications as required

Work Environment & Physical Requirements

  • Primarily office-based role requiring extended periods of sitting and computer use

  • Frequent communication via phone and email

  • Occasional light physical activity (lifting, reaching, etc.) consistent with a standard office environment

Why This Opportunity Stands Out

This is not an entry-level examiner role. If you’re used to handling basic claims, you’ll get exposed here. This role is built for someone who:

  • Wants ownership of complex files

  • Is confident making decisions within authority

  • Can handle volume without sacrificing quality

If that’s you, this is a strong platform to grow and be recognized.