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Remote Medical Claims Processor Jobs in Cayce, SC

033 Palmetto GBA

Medical Reviewer

Columbia, SC · Remote

Palmetto GBA is a healthcare service administrator and one of the nation's largest providers of high-volume medical claims and transaction processing. We provide services and technology solutions to ...

New

033 Palmetto GBA

Medical Reviewer

Columbia, SC · Remote

Palmetto GBA is a healthcare service administrator and one of the nation's largest providers of high-volume medical claims and transaction processing. We provide services and technology solutions to ...

New

Unum UK

Associate VB Claims Specialist

Columbia, SC · Remote

$25/hr

... medical documentation, when appropriate. * Ensure a timely and well communicated transfer process ... Existing internal remote employees are eligible to apply. Unum and Colonial Life are part of Unum ...

CEI

Inpatient Medical Coder/Auditor

Columbia, SC · Remote

$36/hr

Remote ok, but hybrid preferred Pay: $36 /hour + optional medical, dental, vision, 401(k) match ... review processes * Ability to coordinate with claims and legal departments * Excellent report ...

TRC Talent Solutions

PAR I & II

Columbia, SC · Remote

$17 - $21.75/hr

Medical Billing Specialist 100% Remote $1822/hour | Full-Time | Permanent Opportunity We're growing ... Review UB-04 and/or HCFA 1500 claims for billing accuracy * Investigate eligibility discrepancies ...

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All JobsMedical Claims Processor JobsRemote Medical Claims Processor JobsRemote Medical Claims Processor Jobs in Cayce, SC

Remote Medical Claims Processor information

See Cayce, SC salary details

$12

$18

$23

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

As of Aug 22, 2026, the average hourly pay for remote medical claims processor in Cayce, SC is $18.09, according to ZipRecruiter salary data. Most workers in this role earn between $16.11 and $20.10 per hour, depending on experience, location, and employer.

What is a remote medical claims processor?

Remote medical claims processors handle billing paperwork for health care offices or insurance companies. Instead of working in the office, remote medical claims processors complete their job duties from home or another location outside of the office with internet connectivity. As a remote medical claims processor, your responsibilities include ensuring medical insurance claims have proper billing codes that match the services provided, clarifying patient concerns about benefits, and adding changes made to the claim by the doctors or insurer. You may also be required to follow up with the insurer to find out the status of claims and discuss any discrepancies.

What does a remote medical claims processor do?

A Remote Medical Claims Processor reviews, evaluates, and processes insurance claims submitted by healthcare providers and patients. Working from a remote location, they verify the accuracy of claim information, ensure proper coding, and determine whether services are covered based on insurance policies. They also communicate with providers, patients, and insurance companies to resolve discrepancies or request additional information. This role helps ensure that claims are processed efficiently and accurately for timely reimbursement.

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

To thrive as a Remote Medical Claims Processor, a solid understanding of medical terminology, insurance policies, and claims adjudication is essential, typically supported by a high school diploma or equivalent and relevant experience. Familiarity with claims management software, electronic health records (EHR) systems, and knowledge of HIPAA regulations are typically required. Attention to detail, strong organizational skills, and clear written communication help individuals excel in processing claims accurately and efficiently. These skills ensure timely and correct claims processing, reducing errors and supporting the financial health of both healthcare providers and patients.

How does a remote medical claims processor typically collaborate with healthcare providers and insurance companies while working from home?

As a Remote Medical Claims Processor, collaboration with healthcare providers and insurance companies primarily occurs through secure digital communication channels, such as email, specialized claims management software, and phone calls. You will regularly interact with provider offices to clarify patient information, verify coverage, or resolve discrepancies in submitted claims. While the role is independent, you often coordinate with team members and supervisors virtually to ensure claims are processed efficiently and accurately. Maintaining clear documentation and communication is essential for resolving issues and minimizing processing delays.

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

AspectRemote Medical Claims ProcessorRemote Medical Billing Specialist
CredentialsTypically requires medical coding or claims processing certificationsOften requires medical billing certifications and coding knowledge
Work EnvironmentRemote, healthcare or insurance companiesRemote, healthcare providers or billing companies
Industry UsageInsurance companies, third-party administratorsHospitals, clinics, billing service providers
Job FocusProcessing and reviewing insurance claims for reimbursementPreparing and submitting bills, managing accounts receivable

While both roles work remotely within the healthcare industry, the Remote Medical Claims Processor primarily reviews and processes insurance claims, focusing on reimbursement. In contrast, the Remote Medical Billing Specialist handles billing procedures, including preparing and submitting invoices. Both roles require similar certifications and often overlap in work environment and employer types, but their core responsibilities differ in claim review versus billing management.

More about Remote Medical Claims Processor jobs

What cities near Cayce, SC are hiring for Remote Medical Claims Processor jobs?

Cities near Cayce, SC with the most Remote Medical Claims Processor job openings:

Remote Medical Claims Processor jobs near you
Infographic showing various Remote Medical Claims Processor job openings in Cayce, SC as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 18% Part Time, and 6% Contract. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $37,631 per year, or $18.1 per hour.

Business Analyst (Policy remediation) - Contract - Remote

SUNSHINE ENTERPRISE USA LLC

Columbia, SC • Remote

Contractor

Re-posted 24 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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