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Remote Medical Claims Processing Jobs in New Mexico

Workit Health

RCM Specialist

Albuquerque, NM · On-site +1

$18.75 - $25.75/hr

Identify and resolve claims processing issues, including pre-submission errors, and generate ... Submit medical records to insurance when needed * Review and audit patient accounts for accuracy

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Remote Medical Claims Processing information

See New Mexico salary details

$13

$18

$24

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

As of Aug 18, 2026, the average hourly pay for remote medical claims processing in New Mexico is $18.87, according to ZipRecruiter salary data. Most workers in this role earn between $16.78 and $20.96 per hour, depending on experience, location, and employer.

What is remote medical claims processing?

Remote medical claims processing involves reviewing, validating, and submitting health insurance claims from a location outside of a traditional office, often from home. Professionals in this role analyze patient data, ensure claims are accurate and complete, and handle communication with insurance companies to facilitate timely reimbursement. This job requires strong attention to detail, knowledge of medical terminology and billing codes, and proficiency with healthcare management software. Many employers offer remote positions to streamline operations and accommodate flexible work arrangements.

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

To thrive as a Remote Medical Claims Processor, you need a strong understanding of medical terminology, insurance policies, and claims adjudication, typically supported by a high school diploma or an associate degree in health administration. Proficiency with claims management software, electronic health record (EHR) systems, and familiarity with coding systems like ICD-10 and CPT is essential. Attention to detail, time management, and effective written communication are standout soft skills in this role. These skills and qualities ensure accurate, efficient claims processing and help maintain compliance with healthcare regulations.

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

Remote medical claims processors often face challenges such as maintaining clear communication with team members, managing a high volume of claims efficiently, and staying updated on frequently changing insurance policies. To manage these challenges, it's important to utilize collaboration tools, participate in regular virtual meetings, and establish a structured daily routine. Additionally, leveraging secure digital resources and ongoing training can help ensure accuracy and compliance, making remote work both productive and rewarding.

What is the difference between Remote Medical Claims Processing vs Remote Medical Billing Specialist?

AspectRemote Medical Claims ProcessingRemote Medical Billing Specialist
CredentialsKnowledge of insurance policies, claims processing certifications often preferredMedical billing certifications, coding credentials like CPC or CCS+
Work EnvironmentHome-based, computer-focused, insurance company or third-party payerHome-based, healthcare provider offices, billing companies
Industry UsageInsurance companies, third-party administratorsHospitals, clinics, medical practices
Search & Comparison IntentFocus on claims processing tasks, insurance reimbursementFocus on billing, coding, and invoicing processes

Remote Medical Claims Processing involves reviewing and submitting insurance claims for reimbursement, often requiring knowledge of insurance policies. Remote Medical Billing Specialists handle invoicing and coding for healthcare providers. While both roles are home-based and involve healthcare finance, claims processing emphasizes insurance submission, whereas billing focuses on patient invoicing and coding accuracy.

What are popular job titles related to Remote Medical Claims Processing jobs in New Mexico?

For Remote Medical Claims Processing jobs in New Mexico, the most frequently searched job titles are:

What job categories do people searching Remote Medical Claims Processing jobs in New Mexico look for?

The top searched job categories for Remote Medical Claims Processing jobs in New Mexico are:

What cities in New Mexico are hiring for Remote Medical Claims Processing jobs?

Cities in New Mexico with the most Remote Medical Claims Processing job openings:

Remote Medical Claims Processing jobs near you
Infographic showing various Remote Medical Claims Processing job openings in New Mexico as of August 2026, with employment types broken down into 1% As Needed, 76% Full Time, 16% Part Time, 1% Temporary, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $39,241 per year, or $18.9 per hour.

AVP Claims & Configuration - REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$164K - $279K/yr

Full-time

Posted 14 days ago

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

16th of 112 rated pharmacies

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
AVP Claims & Configuration - REMOTEJob Description
The Associate Vice President, Claims & Configuration is responsible for the strategic leadership, operational performance, and continuous evolution of pharmacy benefit claims adjudication, benefit configuration capabilities, and network operations. This role ensures accurate, compliant, and scalable administration of pharmacy benefit programs while driving technology modernization, operational efficiency, and client satisfaction.
Responsibilities
  • Lead cross-functional teams responsible for claims adjudication, benefit configuration, testing, and production support
  • Drive modernization and continuous improvement initiatives that enhance operational efficiency, scalability, accuracy, data-driven decision making and customer experience
  • Own execution of the strategy, roadmap, and governance for pharmacy claims adjudication and benefit configuration capabilities, ensuring alignment with business, client, and regulatory requirements
  • Oversee the accurate interpretation and implementation of client benefit plans, formularies, accumulators, pricing, utilization management rules, and clinical programs within claims processing systems
  • Collaborate with key internal partners and business leaders to prioritize enhancements, drive operational transformation to support technology changes, and deliver strategic business outcomes
  • Establish and monitor key performance, quality, compliance, and financial metrics to ensure claims adjudication accuracy, configuration integrity, service excellence, and regulatory compliance
  • Lead operational initiatives to simplify processes, reduce operational risk, improve speed-to-market, and address technical debt across claims and configuration ecosystems
  • Develop organizational capability through talent management, succession planning, budget oversight, and leadership of high-performing teams focused on operational excellence
  • Other duties as assigned

Minimum Qualifications
  • Bachelor's degree in Business, Health Care Administration, or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED required
  • 12 years of work experience in PBM, health plan, or healthcare operations, including experience with large scale platform enabled transformations
  • 8 years of leadership/people management experience
  • Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications
  • Demonstrated ability to distill complex concepts or situations into concise and compelling communications
  • Advanced problem-solving skills, including the ability to assess operational, financial, compliance, and client impacts of business decisions
  • Executive presence with exceptional communication, influencing, and stakeholder management skills across operations, technology, clinical, product, and client-facing teams
  • Strong understanding of regulatory and industry requirements impacting pharmacy benefit administration and claims processing
  • Expertise in operational excellence, quality management, risk mitigation, and governance practices within highly regulated environments
  • Ability to lead and develop high-performing teams through coaching, succession planning, organizational design, and talent development

Preferred Qualifications
  • PBM experience, including claims adjudication, benefit configuration, formulary management, pricing, accumulators, and clinical program administration
  • Experience with pharmacy claims adjudication platforms, benefit configuration systems, and implementation of complex client benefit plans

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job
Potential pay for this position ranges from $164,000.00 - $279,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.

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About Prime Therapeutics

Sourced by ZipRecruiter

Prime Therapeutics, located in Eagan, MN, is a pharmacy benefits management company that has been serving the healthcare industry since its foundation. They are an integral participant in the medical sector, specifically in the realm of health insurance. They focus on providing innovative pharmacy benefits and services to more than 30 million members nationwide. Besides their main pharmacy benefit management, they offer mail service pharmacy, specialty pharmacy, benefits management, and consultative engagement services to ensure individuals have continuous access to affordable prescription drugs. Prime Therapeutics, founded around three decades ago, has grown to stand out as a leader in its industry, thanks to its commitment to improving the health of its clients.

Industry

Insurance services

Company size

1,001 - 5,000 Employees

Headquarters location

Eagan, MN, US

Year founded

1987

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