ZipRecruiter

Log In

2

Remote Medical Claims Processor Jobs in Rio Rancho, NM

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

micro1 AI

Medical Writing Manager

Albuquerque, NM · 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 Writing Manager

Rio Rancho, NM · 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

Albuquerque, NM · 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

Rio Rancho, NM · 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 ...

USAA

SIU Investigator I

Albuquerque, NM · On-site +1

$77K - $147K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with ... claims handling process and procedures. * Applies knowledge of state laws and regulations ...

New

next page

Showing results 1-20

All JobsMedical Claims Processor JobsRemote Medical Claims Processor JobsRemote Medical Claims Processor Jobs in Rio Rancho, NM

Remote Medical Claims Processor information

See Rio Rancho, NM salary details

$13

$18

$24

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

As of Aug 14, 2026, the average hourly pay for remote medical claims processor in Rio Rancho, NM is $18.31, according to ZipRecruiter salary data. Most workers in this role earn between $16.30 and $20.34 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 popular job titles related to Remote Medical Claims Processor jobs in Rio Rancho, NM?

For Remote Medical Claims Processor jobs in Rio Rancho, NM, the most frequently searched job titles are:

What job categories do people searching Remote Medical Claims Processor jobs in Rio Rancho, NM look for?

The top searched job categories for Remote Medical Claims Processor jobs in Rio Rancho, NM are:

What cities near Rio Rancho, NM are hiring for Remote Medical Claims Processor jobs?

Cities near Rio Rancho, NM 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 Rio Rancho, NM as of August 2026, with employment types broken down into 88% Full Time, 8% Part Time, 2% Temporary, and 2% Contract. Highlights an 100% Remote job distribution, with an average salary of $38,088 per year, or $18.3 per hour.

AVP Claims & Configuration - REMOTE

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

$164K - $279K/yr

Full-time

Posted 9 days ago

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

17th 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.

What Prime Therapeutics employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Prime Therapeutics logo

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

Social media

FacebookTwitter

View All Prime Therapeutics Jobs

Apply