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Remote Medical Claims Processor Jobs in Oak Ridge, TN

HomeFirst Agency

Claims Adjuster

Maryville, TN · On-site +1

Hybrid - 3 days in office, 2 days remote after training. PAY: T h e expected hiring range for this ... Maintainsworkflow to ensure timely processing of claims. * Partners withClaimsleadershipon ...

USAA

Sr. Auto Appraiser- Field

Alcoa, TN · On-site +1

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Maintains accurate and current claim file documentation throughout the claims process for complex ...

New

USAA

Sr. Auto Appraiser- Field

Knoxville, TN · On-site +1

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... Maintains accurate and current claim file documentation throughout the claims process for complex ...

micro1 AI

Medical Writing Manager

Knoxville, TN · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Trace narrative claims to source records--tables, figures, listings, and protocols--to verify that ...

micro1 AI

Medical Billing Specialist

Knoxville, TN · Remote

$50 - $80/hr

Remote micro1 is engaging Medical Writers / Clinical Document Authors to participate in a customer ... Trace narrative claims to source records--tables, figures, listings, and protocols--to verify that ...

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All JobsMedical Claims Processor JobsRemote Medical Claims Processor JobsRemote Medical Claims Processor Jobs in Oak Ridge, TN

Remote Medical Claims Processor information

See Oak Ridge, TN salary details

$13

$18

$24

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

As of Aug 11, 2026, the average hourly pay for remote medical claims processor in Oak Ridge, TN is $18.61, according to ZipRecruiter salary data. Most workers in this role earn between $16.54 and $20.67 per hour, depending on experience, location, and employer.

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.

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 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 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.
More about Remote Medical Claims Processor jobs
What are the most commonly searched types of Medical Claims Processor jobs in Oak Ridge, TN? The most popular types of Medical Claims Processor jobs in Oak Ridge, TN are:
What job categories do people searching Remote Medical Claims Processor jobs in Oak Ridge, TN look for? The top searched job categories for Remote Medical Claims Processor jobs in Oak Ridge, TN are:
What cities near Oak Ridge, TN are hiring for Remote Medical Claims Processor jobs? Cities near Oak Ridge, TN with the most Remote Medical Claims Processor job openings:
Remote Medical Claims Processor jobs near you

Claims Adjuster

HomeFirst Agency

Maryville, TN • On-site, Remote

Full-time

Medical, Dental, Vision, Retirement

Posted 28 days ago

Job description

POSITION TITLE: Claims Adjuster I

JOB STATUS:Full-time/Hourly

DEPARTMENT: Claims

REPORTS TO:Claims Team Lead

TRAVEL REQUIRED:Asneeded

WORK SCHEDULE: Hybrid - 3 days in office, 2 days remote after training.

PAY: The expected hiring range for this position is from $21.69 to $27.11 plus additional bonus opportunity. The stated hiring range is based on experience, qualifications, and other relevant factors. Final compensation decisions will take into account a variety of considerations, including individual skills, internal equity, and organizational needs.

HomeFirst Agency is a leading insurance agency offering a wide range of insurance products from nationally-known insurance companies to protect your home, property and life. We strive to help customers find the right insurance products to fit their needs at competitive rates. Located in Maryville, Tennessee, we offer homeowners insurance to customers nationwide, and insurance to protect your other property and life in select states. For over 20 years, we have helped customers with their insurance needs. Today, we have more than 180,000 customers.

JOB SUMMARY

The Claims Adjuster Ireviewsclaims related to property damage or loss.This position reports to the Claims Team Lead andworks with various experts during the claims process to obtain accurate assessments and supportinclaims decisions.The Claims Adjuster Ipartners withClaims Trainer and Claims Team Leadtointerpret the terms and conditions ofinsurance policiesto determine coverage and exclusions applicable to each claim.This position also engages with policyholders to gather information, provide updates on the status of claims, and explain the claims process and decisions.

JOBFUNCTIONS:

ClaimsHandlingandInvestigating

  • Maintainsaccurate and detailed notes regarding interactions, decisions, and actions taken throughout a claim.

  • Partners with Claims Team Lead and Trainers to review, evaluate, and investigate photos, estimates, forms, receipts, inspection reports, and official reports presented on a claim.

  • Reviews, partners,and processesproperty damage claims submitted by policyholders.

  • Reviews insurance policies to determine coverageby working with Claims Trainers and leadershiptointerpret and apply policy provisions to claimsunder considerationbased on coverage and investigation findings.

  • Conducts,records, andinterviews withthoseinsuredtosecure information regardingpersonalloss.

  • Workswith claimants orrepresentativesofclaimants(contractors, public adjusters,attorneys, or other legal representatives)to gather necessary information regarding the claim andto negotiate fair and equitable settlements, overseen by Claims Team Lead.

  • Collaborateswith other insurancecarriers as needed regarding duplicate claims and coverage.

  • Selects and assignsclaims for inspections.

  • Requests and issues settlement checkswithexplanation lettersbased on policy terms and investigation findings,withlimitedauthority.

  • Preparesand issuesdenial letters toclaimants, clearly outlining the reasons for denial based on policy terms and investigation findings.

  • Identifiespotential fraudulent claims and refersfor additional investigation as warranted.

  • Ensures claimshandling complies with company and regulatory policies.

  • Escalates complex insurance claims tomanagementand legal teamsincludingthose subject to complaints and litigation.

  • Consults withClaims TeamLeadstoresolve disagreements with a claim,utilizing alternative dispute resolutions(arbitration,appraisal, and mediation).

  • Collaborateswith management on arbitration, appraisal, and mediations.

  • Maintainsworkflow to ensure timely processing of claims.

  • Partners withClaimsleadershipon difficult or unusual situations that arise onclaims.

  • Prepares responselettersto complaints or legal issuesreceived.

Customer Service

  • Provides excellent customer service bymaintainingprofessional and constant dialogue with claimantsin addition tohandling claims promptly, efficiently, and with empathy.

  • Communicates regularlywith policyholders or other relevant partiesprovidingupdates on the status of claims and addressingany questions or concerns.

  • Provides supporttorelated teams during high work volumeto meet or exceed established service levels.

  • Educatespolicyholders on the claim process and coveragesby maintaining open communication throughout the claim duration.

  • Sorts and responds to incoming emails.

Training and Education

  • Assists with one-on-one training or job shadowing for new hires.

  • Completesrequired state continuing education requirements to maintainand renewadjuster license.

Other duties as assigned

This job description is not an exhaustive list of all the functions that a team memberperformsand other duties may be assigned.

QUALIFICATIONS:

  • Education:High School diploma or equivalentrequired, collegedegreepreferred.

  • Experience:0-2 years of related experiencepreferred.

  • Travel as needed.

  • Must have strong computer skills with ability to navigate Microsoft Office Suite.

  • Maintains excellent knowledge of state and federal laws and regulations.

  • Ability to communicate effectively and efficiently via phone, email, and person to person.

  • Capability of gathering facts accurately, analyzing causes, evaluating alternate solutions, and arriving at sound conclusions on action to be taken.

  • Ability to manage multiple and/or conflicting responsibilities.

  • Great attention to detail, organizational skills, and time management.

  • Good sense of urgency and follow up.

  • Ability to handle stressful situations.

  • Ability to work in a team environment.

  • Ability to makerelativelycomplex decisions.

Licenses/Certifications:A current Property & Casualty Adjuster license preferred but not required. Must obtain license within 90 days of hire if not currently licensedand maintain state licensing requirements through the completion of continuing education when required by the state.

Knowledge, Skills and Abilities (KSAs):

  • Must have strong computer skills with ability to navigate Microsoft Office Suite

  • Maintains excellent knowledge of state and federal laws and regulations

  • Claims experience helpful, working knowledge of AS/400 and basic understanding of insurance a plus

  • Ability to communicate effectively and efficiently via phone, email, and person to person

  • Capable of gathering facts accurately, analyze causes, evaluate alternate solutions, and arriving at sound conclusions on action to be taken

  • Ability to manage multiple and/or conflicting responsibilities

  • Great attention to detail, organizational skills, and time management

  • Good sense of urgency and follow up

  • Ability to handle stressful situations

  • Ability to work in a team environment

  • Capable of dealing with changes that can and will occur periodically

  • Ability to make complex decisions

PHYSICAL DEMANDS:

  • Must be able to remain in a stationary position 75% of the time.

  • Will be constantly operating a computer and other office productivity machinery, such as a telephone, calculator, copy machine, and computer printer.

  • Will be communicating via phone, Teams, andZoom.

  • Must be able to exchange accurate information at all times.

  • Must be able to identify and assess account status and determine appropriate process.

  • Willprimarilywork in a state-of-the-art indoor temperature controlled, sealed window office environment, while working a hybrid schedule.

Here are some more reasons to choose HomeFirst Agency!

  • Full-time team members have the flexibility to create their own health, dental, and vision benefits package. HomeFirst Agency provides competitive 401(k) programs, including investment options and company matching for full and part time team members after one year to help our team members achieve their financial goals. Additional benefits include paid parental leave, tuition reimbursement, Employee Assistance Programs, and more.

  • As part of HomeFirst's commitment to Opening Doors to a Better Life, HFA is now providing paid time for Team Members to volunteer to causes that are meaningful to them through the Clayton Impact program.

  • At HFA, we encourage holistic wellness with physical, nutritional, social, financial, spiritual, and occupational programs available online or in-person for team members.

  • Our newly renovated Home Office campus offers an onsite restaurant, onsite fitness facility with full gym, in-person and virtual workout classes, yoga/barre studio, volleyball, and basketball courts, walking paths, and a disc golf course.

Clayton is committed to creating an inclusive workplace. HomeFirst Agency is an equal opportunity employer and does not discriminate on the basis of race, national origin, gender, gender identity, sexual orientation, protected veteran status, disability, age, or other legally protected status.

HomeFirst Agency. Where you start a job and gain a career!

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