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Remote Medical Claims Processor information

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

As of Aug 26, 2026, the average hourly pay for remote medical claims processor in Pittsburgh, PA is $17.66, according to ZipRecruiter salary data. Most workers in this role earn between $15.67 and $19.62 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 are the most commonly searched types of Medical Claims Processor jobs in Pittsburgh, PA?

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Remote Medical Claims Processor jobs near you
Infographic showing various Remote Medical Claims Processor job openings in Pittsburgh, PA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 90% Physical, 1% Hybrid, and 9% Remote job distribution, with an average salary of $39,310 per year, or $18.9 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 5 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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