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Remote Medical Claims Specialist Jobs in Rio Rancho, NM

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 ...

micro1 AI

Regulatory Affairs Specialist

Rio Rancho, NM · Remote

$50 - $70/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... conflicting claims within or between documents. * Provide structured, well-reasoned written ...

micro1 AI

Regulatory Affairs Specialist

Albuquerque, NM · Remote

$50 - $70/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... conflicting claims within or between documents. * Provide structured, well-reasoned written ...

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 ...

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REMOTE Insurance Defense Litigation Attorney (New Mexico Bar Required)

Albuquerque, NM · Remote

$150K - $205K/yr

Medical Malpractice Defense * Product Liability * Premises Liability * Construction Defect * First ... Claims * Property Damage Litigation * Insurance Coverage Analysis * Bad Faith Litigation

micro1 AI

Compliance Officers

Rio Rancho, NM · Remote

$50 - $70/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... conflicting claims within or between documents. * Provide structured, well-reasoned written ...

micro1 AI

Compliance Officers

Albuquerque, NM · Remote

$50 - $70/hr

Remote micro1 is engaging Regulatory Affairs Specialists to contribute to a customer's project ... conflicting claims within or between documents. * Provide structured, well-reasoned written ...

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Remote Medical Claims Specialist information

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

As of Aug 10, 2026, the average hourly pay for remote medical claims specialist in Rio Rancho, NM is $20.89, according to ZipRecruiter salary data. Most workers in this role earn between $17.16 and $23.08 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a remote medical claims specialist, and why are they important?

To thrive as a Remote Medical Claims Specialist, you need a solid understanding of medical billing, insurance claims processing, and healthcare terminology, often supported by a relevant associate degree or certification such as Certified Professional Biller (CPB). Familiarity with claims management software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is typically required. Attention to detail, strong organizational skills, and effective written communication are key soft skills for success in this role. These competencies ensure accurate claims processing, minimize errors and denials, and support timely reimbursement in a remote work environment.

How do remote medical claims specialists typically communicate and collaborate with other departments while working from home?

Remote Medical Claims Specialists frequently engage with billing teams, healthcare providers, and insurance representatives through secure digital platforms such as email, video conferencing, and specialized claims management software. Regular virtual meetings and collaboration tools are used to ensure timely resolution of claims and to clarify any discrepancies. Maintaining clear communication and meticulous documentation is essential, as it helps streamline the claims process and fosters teamwork despite the physical distance.

What is a remote medical claims specialist?

A Remote Medical Claims Specialist is a professional who processes and reviews medical insurance claims from a remote location, such as a home office. They verify patient information, ensure the accuracy of submitted claims, and communicate with healthcare providers, insurance companies, and patients to resolve discrepancies. Their main goal is to facilitate timely and accurate reimbursement for medical services while adhering to legal and regulatory requirements. This job requires attention to detail, knowledge of medical coding, and strong communication skills.

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

AspectRemote Medical Claims SpecialistRemote Medical Billing Specialist
CertificationsCPR, Medical Claims Processing CertificationMedical Billing Certification, CPC
Work EnvironmentHealthcare offices, insurance companies, remoteMedical offices, billing companies, remote
Job FocusReviewing and processing insurance claimsCreating and submitting billing invoices
Employer UsageHospitals, insurance providers, healthcare organizationsMedical practices, billing services, healthcare providers

While both roles involve working with healthcare financial processes, the Remote Medical Claims Specialist primarily reviews and processes insurance claims, ensuring accurate reimbursement. The Remote Medical Billing Specialist focuses on creating and submitting billing invoices to healthcare providers or insurance companies. Both roles require similar certifications and often operate in remote healthcare environments, but their core responsibilities differ in claim review versus billing creation.

What does a remote medical claims specialist do?

A remote medical claims specialist manages and organizes data by ensuring that it maintains accuracy, security, quality, and accessibility in electronic systems and paper files. As a work from home medical claims specialist, your responsibilities include reviewing patient records for completeness, appropriateness, timeliness, and accuracy of data. Your duties also include maintaining and organizing registry and clinical database information, as well as obtaining prior authorization for a patient from their health insurance before a treatment or procedure. You may verify patient eligibility, contact other healthcare providers to ensure the accuracy of medical records, and assign clinical codes via classification software for data analysis and reimbursement.

More about Remote Medical Claims Specialist jobs
What are popular job titles related to Remote Medical Claims Specialist jobs in Rio Rancho, NM? For Remote Medical Claims Specialist jobs in Rio Rancho, NM, the most frequently searched job titles are:
What job categories do people searching Remote Medical Claims Specialist jobs in Rio Rancho, NM look for? The top searched job categories for Remote Medical Claims Specialist jobs in Rio Rancho, NM are:
What cities near Rio Rancho, NM are hiring for Remote Medical Claims Specialist jobs? Cities near Rio Rancho, NM with the most Remote Medical Claims Specialist job openings:
Remote Medical Claims Specialist jobs near you
Infographic showing various Remote Medical Claims Specialist job openings in Rio Rancho, NM as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $43,454 per year, or $20.9 per hour.

Pharmacy Claims Adjudication Specialist

Onco360

Albuquerque, NM • Remote

$22/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 11 days ago

Onco360 rating

7.7

Company rating: 7.7 out of 10

Based on 5 frontline employees who took The Breakroom Quiz

21st of 112 rated pharmacies

Job description

We are seeking a Pharmacy Adjudication Specialist at our Specialty pharmacy working in Mountain Time Zone. This will be a Full-Time position. This is a remote/hybrid opportunity,
Shift times start at 10am Mountain Time Zone until 8pm Mountain Time Zone.
Full-Time position may work remotely but MUST HAVE ACTIVE NEW MEXICO PHARMACY TECHNICIAN credentials from the State Board of Pharmacy.
Onco360 Pharmacy is a unique oncology pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers.
Starting salary from $22.00 an hour and up
Sign-On Bonus: $5,000 for employees starting before September 30th, 2026.
We offer a variety of benefits including:
  • Medical; Dental; Vision
  • 401k with a match
  • Paid Time Off and Paid Holidays
  • Tuition Reimbursement
  • Company paid benefits – life; and short and long-term disability
Pharmacy Adjudication Specialist Major Responsibilities:
The Pharmacy Adjudication Specialist will adjudicate pharmacy claims, review claim responses for accuracy. ensure prescription claims are adjudicated correctly according to the coordination of benefits, resolve any third-party rejections, obtain overrides if appropriate, and be responsible for patient outreach notification regarding any delay in medication delivery due to insurance claim rejections
Pharmacy Adjudication Specialists at Onco360...
  • Practices first call resolution to help health care providers and patients with their pharmacy needs, answering questions and requests.
  • Provides thorough, accurate and timely responses to requests from pharmacy operations, providers and/or patients regarding active claims information..
  • Ensures complete and accurate patient setup in CPR+ system including patient demographic and insurance information.
  • Adjudicates pharmacy claims for prescriptions in active workflow for primary, secondary, and tertiary pharmacy plans and reviews claim responses for accuracy before accepting the claim.
  • Contacts insurance companies to resolve third-party rejections and ensures pharmacy claim rejections are resolved to allow for timely shipping of medications. Performs outreach calls to patients or providers to reschedule their medication deliveries if claim resolution cannot be completed by ship date and causes shipment delays
  • Ensures copay cards are only applied to claims for eligible patients based on set criteria such as insurance type (Government beneficiaries not eligible)
  • Manages all funding related adjudications and works as a liaison to Onco360 Advocate team.
  • Assists pharmacy team with all management of electronically adjudicated claims to ensure all prescription delivery assessments are reconciled and copay payments are charged prior to shipment.
  • Serves as customer service liaison to patients regarding financial responsibility prior to shipments, contacts patients to communicate any copay discrepancy between quoted amount and claim and collects payment if applicable.
  • Documenst and submit requests for Patient Refunds when appropriate.
  • Maintain a safe and clean pharmacy by complying with procedures, rules, and regulations and compliance with professional practice and patient confidentiality laws.
  • Contributes to team effort by accomplishing related tasks as needed and other duties as assigned.
  • Conducts job responsibilities in accordance with the standards set out in the Company’s Code of Business Conduct and Ethics, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.
Pharmacy Adjudication Specialist Qualifications and Responsibilities...
  • Education/Learning Experience
    • Required: High School Diploma or GED. Previous Experience in Pharmacy, Medical Billing, or Benefits Verification, Pharmacy Claims Adjudication
    • Desired: Associate degree or equivalent program from a 2 year program or technical school, Certified Pharmacy Technician, Specialty pharmacy experience
  • Work Experience
    • Required: 2+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
    • Desired: 3+ years experience in Pharmacy/Healthcare Setting or pharmacy claims experience
  • Skills/Knowledge
    • Required: Pharmacy/NDC medication billing, Pharmacy claims resolution, PBM and Medical contracts, knowledge/understanding of Medicare, Medicaid, and commercial insurance, NCPDP claim rejection resolution, coordination of benefits, pharmacy or healthcare-related knowledge, knowledge of pharmacy terminology including sig codes, and Roman numerals, brand/generic names of medication, basic math and analytical skills, Intermediate typing/keyboarding skills
    • Desired: Knowledge of Foundation Funding, Specialty pharmacy experience
  • Licenses/Certifications
    • Required: Registration with Board of Pharmacy as required by state law
    • Desired: Certified Pharmacy Technician (PTCB)
  • Behavior Competencies
    • Required: Independent worker, good interpersonal skills, excellent verbal and written communications skills, ability to work independently, work efficiently to meet deadlines and be flexible, detail-oriented, great time-management skills

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