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Remote Medical Claims Jobs in Rio Rancho, NM (NOW HIRING)

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

... claims. * Collects evidence of potential fraud through field or remote interviews and thorough ... These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life ...

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

Remote Medical Claims information

See Rio Rancho, NM salary details

$13

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How much do remote medical claims jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for remote medical claims 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 is the difference between Remote Medical Claims vs Remote Medical Billing?

AspectRemote Medical ClaimsRemote Medical Billing
CertificationsTypically requires CPC, CCS, or similar claims processing certificationsOften requires CPC, CPC-H, or billing-specific certifications
Work EnvironmentPrimarily involves reviewing and submitting insurance claimsFocuses on creating and submitting patient bills to insurance companies
Employer & Industry UsageUsed by insurance companies, third-party administrators, and healthcare providersUsed mainly by healthcare providers, billing companies, and medical offices

Remote Medical Claims specialists focus on processing and submitting insurance claims, ensuring compliance and accuracy. Remote Medical Billing professionals handle creating patient invoices and submitting bills to insurance companies. While both roles require similar certifications and work in healthcare, their core functions differ—claims processing vs billing. Understanding these distinctions helps job seekers find the right remote healthcare role.

What is a remote medical claims job?

Remote medical claims jobs involve reviewing, processing, and managing health insurance claims from a location outside of a traditional office, typically from home. Professionals in this field assess medical records, verify patient information, ensure compliance with insurance policies, and determine the appropriate payment or denial of claims. These roles often require knowledge of medical terminology, coding, and healthcare regulations. Working remotely in this field offers flexibility while still maintaining the accuracy and confidentiality required in handling sensitive patient data.

What skills and qualifications are needed for a remote medical claims specialist?

To thrive as a Remote Medical Claims Specialist, you need a strong understanding of medical billing, insurance procedures, and healthcare regulations, often supported by relevant certifications like Certified Professional Coder (CPC) or Certified Billing and Coding Specialist (CBCS). Familiarity with claims management software, electronic health records (EHR) systems, and payer portals is typically required. Attention to detail, problem-solving abilities, and effective verbal and written communication help ensure accuracy and resolve claim issues efficiently. These skills are crucial for minimizing claim denials, maximizing reimbursements, and maintaining compliance in a remote environment.

What are common challenges in remote medical claims roles and how can they be managed?

One common challenge in remote medical claims roles is ensuring clear and timely communication with both healthcare providers and insurance companies, as miscommunication can lead to claim delays or denials. Additionally, managing a high volume of claims while maintaining accuracy requires strong organizational skills and attention to detail. To manage these challenges, professionals often rely on digital collaboration tools, regular team check-ins, and thorough knowledge of medical billing codes and insurance policies. Establishing a structured daily workflow and seeking continuous training on regulatory updates can also help remote medical claims specialists stay efficient and compliant.

What are popular job titles related to Remote Medical Claims jobs in Rio Rancho, NM?

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

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

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

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

Cities near Rio Rancho, NM with the most Remote Medical Claims job openings:

Remote Medical Claims jobs near you
Infographic showing various Remote Medical Claims job openings in Rio Rancho, NM as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 16% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $43,454 per year, or $20.9 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

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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

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