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Remote Medical Claims Processing Jobs in Pennsylvania

Great American Insurance Group

$18.50 - $25.50/hr

... processing, and administration of workers' compensation claims. This position serves as a key ... This is a remote, work-from-home position. Candidates must reside within the Pacific Time Zone and ...

Great American Insurance Group

$20 - $27/hr

... and processed accurately and efficiently. This role serves as a key partner to adjusters by ... This is a remote, work-from-home position for candidates located within the Mountain or Central ...

Great American Insurance Group

$20 - $27/hr

... and processed accurately and efficiently. This role serves as a key partner to adjusters by ... This is a remote, work-from-home position for candidates located within the Mountain or Central ...

Great American Insurance Group

$20 - $27/hr

... and processed accurately and efficiently. This role serves as a key partner to adjusters by ... This is a remote, work-from-home position for candidates located within the Mountain or Central ...

Allcat Claims Service

Claims Examiner

North East, PA · On-site +1

Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties ... Medical, Dental, Vision, Paid Time Off and Paid Holidays, 401(K), in accordance with Company policy.

Gallagher

Claims Adjuster Senior

Mechanicsburg, PA · Remote

Whether you're managing claims, supporting clients, or improving processes, you'll play a vital ... This role is fully remote How you'll make an impact * Apply claims management experience to execute ...

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Remote Medical Claims Processing information

See Pennsylvania salary details

$13

$19

$25

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

As of Aug 28, 2026, the average hourly pay for remote medical claims processing in Pennsylvania is $19.51, according to ZipRecruiter salary data. Most workers in this role earn between $17.36 and $21.68 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 Pennsylvania?

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

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

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

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

Cities in Pennsylvania 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 Pennsylvania as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 20% Part Time, and 6% Contract. Highlights an 89% Physical, 1% Hybrid, and 10% Remote job distribution, with an average salary of $40,590 per year, or $19.5 per hour.

Medical Only Claims Specialist I - Pittsburgh

Pittsburgh, PA • Remote

UPMC Health Plan
Insurance Services • 1 - 5K employees
Learn more about UPMC Health Planexternal

Full-time

Posted 7 days ago

Job description

UPMC WorkPartners is hiring a full-time Medical Only Claims Specialist I to join the Workers Comp Claims team. This role follows a standard Monday through Friday schedule during daylight hours. The position is primarily remote, with occasional in-office presence required-typically once a month-at the U.S. Steel Tower. Candidates should reside locally in the Pittsburgh area.

The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 1 reports to the Workers' Compensation Supervisor. This is an entry level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 1 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards.
Responsibilities:

  • Manage non-complex and non-problematic medical-only and restricted medical only, claims under close supervision.
  • Additional duties as required.Appropriate state licensing to be secured as needed.Excellent communication skills.
  • Adhere to client and carrier guidelines and special handling requests.
  • Communicate claim status with the injured worker, insured/employer, and broker as needed.
  • Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor
  • Receives claim, confirms policy coverage and acknowledgement of the claim
  • Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision.
  • Establish reserves and authorize payments within authority limits.
  • Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information.
  • Review invoices and medical records to determine eligibility for payment or denial.
  • Determine validity and compensability of the claim.
  • Participate in periodic claim reviews as needed.
  • Participate in monthly account renewal meetings as needed.
  • Bachelor's and/or advanced degree or a minimum of 1 year of administrative, claims, and/or customer service experience, preferably in Workers' Compensation.
  • Prior workers comp claims experience strongly preferred.
  • Demonstrated verbal and written communications skills.
  • Demonstrated analytical and decision-making skills.
  • Appropriate state licensing to be secured as needed.
  • Excellent communication skills.
    Licensure, Certifications, and Clearances:
  • Act 34


UPMC is an Equal Opportunity Employer/Disability/Veteran

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