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Remote Medical Claims Examiner Jobs in Riverside, CA

CCMSI

WC Claim Associate I LevelUP

Irvine, CA · Remote

$19 - $25.75/hr

Overview LevelUP Career Development Program - Claims Trainee (Paid Training) Location: Remote ... Communicate by phone and email with people involved in a claim (injured employees, medical offices ...

CCMSI

WC Claim Associate I LevelUP

Irvine, CA · Remote

$60K - $70K/yr

LevelUP Career Development Program - Claims Trainee (Paid Training) Location: Remote, reporting to ... Communicate by phone and email with people involved in a claim (injured employees, medical offices ...

Crawford and Company

Team Manager - WC

Brea, CA · Remote

... claims management and make a meaningful impact through your expertise ... Why You'll Love Working With Us Remote Position Great Leadership Opportunity Excellent Crawford ...

Jobot

Litigation Attorney (Remote)

Irvine, CA · On-site +1

$170K - $180K/yr

... claims, and product liability matters. Position: Litigation Attorney Salary: $170,000 - $180,000 ... Medical, dental, vision, and life insurance * Flexible time off * 401k retirement plan and profit ...

UnitedHealth Group

Lead Medical Assistant Float

Irvine, CA · Remote

$19 - $25.25/hr

... remote tasking support, and other remote patient care activities. You will build meaningful ... examination, treatment, monitoring, and preparing for diagnostic tests or procedures at various ...

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Remote Medical Claims Examiner information

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

As of Sep 5, 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.

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.

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.

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.

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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 83% Full Time, and 17% Temporary. Highlights an 100% Remote job distribution, with an average salary of $63,802 per year, or $30.7 per hour.

Sr. Claims Specialist - Commercial Auto BI

Philadelphia Insurance Companies

Mission Viejo, CA • On-site, Remote

$102K - $120K/yr

Full-time

Medical, Retirement, PTO

Re-posted 22 days ago

Philadelphia Insurance Companies rating

8.9

Company rating: 8.9 out of 10

Based on 11 frontline employees who took The Breakroom Quiz

50th of 315 rated insurance

Job description

Marketing Statement:

Philadelphia Insurance Companies, a member of the Tokio Marine Group, designs, markets and underwrites commercial property/casualty and professional liability insurance products for select industries. We have been in operation since 1962 and are nationally recognized as a member of Ward's Top 50 and rated A++ by A.M.Best.

We are looking for a Senior Claims Specialist - Commercial Auto BI to join our team!

JOB SUMMARY

Investigate, evaluate and settle more complex first and third party commercial insurance auto claims.

JOB RESPONSIBILITIES

  • Evaluates each claim in light of facts; Affirm or deny coverage; investigate to establish proper reserves; and settles or denies claims in a fair and expeditious manner.
  • Communicates with all relevant parties and documents communication as well as results of investigation.
  • Thoroughly understands coverages, policy terms and conditions for broad insurance areas, products or special contracts.
  • Travel is required to attend customer service calls, mediations, and other legal proceedings.

JOB REQUIREMENTS

  • High School Diploma; Bachelor's degree from a four-year college or university preferred.
  • 15 years related experience and/or training; or equivalent combination of education and experience.

National Range: $102,150.00 - $120,177.00

Ultimate salary offered will be based on factors such as applicant experience and geographic location.

We offer a hybrid work model that provides flexibility to work remotely while maintaining meaningful in-office collaboration with your team.

Remote consideration will be given to qualified candidates located outside of the primary geographic region.

EEO Statement:

Tokio Marine Group of Companies (including, but not limited to the Philadelphia Insurance Companies, Tokio Marine America, Inc., TMNA Services, LLC, TM Claims Service, Inc.and First Insurance Company of Hawaii, Ltd.) is an Equal Opportunity Employer. In order to remain competitive we must attract, develop, motivate, and retain the most qualified employees regardless of age, color, race, religion, gender, disability, national or ethnic origin, family circumstances, life experiences, marital status, military status, sexual orientation and/or any other status protected by law.

Benefits:

We offer a comprehensive benefit package, which includes tuition reimbursement and a generous 401K match. Our rich history of outstanding results and growth allow us to focus our business plan on continued growth, new products, people development and internal career opportunities. If you enjoy working in a fast paced work environment with growth potential please apply online.
Additional information on Volunteer Benefits, Paid Vacation, Medical Benefits, Educational Incentives, Family Friendly Benefits and Investment Incentives can be found at https://www.phly.com/Careers/default.aspx

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