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Remote Medicare Claims Processing Jobs in Michigan

Ourhrconnect

$309K - $413K/yr

We operate one of the most sophisticated data processing centers in the Southeast. We also have a ... This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ...

New

Ourhrconnect

$309K - $413K/yr

We operate one of the most sophisticated data processing centers in the Southeast. We also have a ... This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ...

New

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All JobsMedicare Claims Processing JobsRemote Medicare Claims Processing JobsRemote Medicare Claims Processing Jobs in Michigan

Remote Medicare Claims Processing information

What is remote Medicare claims processing?

Remote Medicare claims processing involves reviewing, verifying, and submitting medical claims to Medicare from a location outside of a traditional office, often from home. Professionals in this role ensure that healthcare providers are reimbursed for services rendered to Medicare patients by checking claims for accuracy, compliance, and eligibility. They use specialized software to process electronic and paper claims, resolve discrepancies, and follow up on denied or delayed payments. This job requires knowledge of Medicare regulations, coding, and strong attention to detail. Remote work allows for flexible scheduling but also demands self-discipline and secure handling of sensitive patient data.

What are the key skills and qualifications needed to thrive as a remote Medicare claims processor?

To thrive as a Remote Medicare Claims Processor, you need strong attention to detail, knowledge of medical billing and coding, and a solid understanding of Medicare regulations, often supported by a relevant certification like CPC or CCA. Familiarity with claims processing software, electronic health record (EHR) systems, and Medicare-specific platforms such as the Fiscal Intermediary Standard System (FISS) is typically required. Strong organizational skills, effective written communication, and problem-solving abilities help you excel in remote work environments. These skills ensure timely and accurate claims processing, minimize errors, and support compliance with complex healthcare regulations.

What are some common challenges faced by remote Medicare claims processors and how can they be managed?

One common challenge for remote Medicare claims processors is staying up-to-date with frequent changes in Medicare regulations and billing codes. Additionally, working remotely can make it harder to quickly clarify complex cases with colleagues or supervisors. To manage these challenges, it's important to participate in regular training sessions, utilize internal communication platforms for collaboration, and maintain organized documentation. Employers often provide digital resources and support channels to help remote processors stay connected and informed.

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

AspectRemote Medicare Claims ProcessingRemote Medical Billing Specialist
CertificationsCPAR, CPC, or similarCPB, CPC, or similar
Work EnvironmentHealthcare insurance, government programsHealthcare providers, clinics, hospitals
Job FocusSubmitting and managing Medicare claimsBilling for various medical services and insurance

Remote Medicare Claims Processing involves handling claims specifically for Medicare, focusing on government regulations and Medicare-specific procedures. Remote Medical Billing Specialists manage billing for a variety of insurance types and healthcare providers. While both roles require similar certifications and work remotely in healthcare settings, Medicare Claims Processing is specialized in government insurance claims, whereas Medical Billing covers broader insurance billing tasks.

What are popular job titles related to Remote Medicare Claims Processing jobs in Michigan?

For Remote Medicare Claims Processing jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Remote Medicare Claims Processing jobs in Michigan look for?

The top searched job categories for Remote Medicare Claims Processing jobs in Michigan are:

What cities in Michigan are hiring for Remote Medicare Claims Processing jobs?

Cities in Michigan with the most Remote Medicare Claims Processing job openings:

Remote Medicare Claims Processing jobs near you
Infographic showing various Remote Medicare Claims Processing job openings in Michigan as of August 2026, with employment types broken down into 89% Full Time, 3% Part Time, and 8% Contract. Highlights an 3% In-person, and 97% Remote job distribution.

Molecular Diagnostics Medicare Medical Director - Palmetto GBA

Ourhrconnect

Wyoming, MI • On-site, Remote

$309K - $413K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 2 days ago

New

Key responsibilities

  • Oversees medical staff, analyzes utilization data, and researches emerging molecular technologies.

  • Develops, writes, and revises medical policies to ensure compliance and support Medicare coverage decisions.

  • Supports operations through case review on medical and regulatory matters, and develops claim adjudication criteria requiring medical judgment.

Job description


Summary
 Why should you join the BlueCross BlueShield of South Carolina family of companies?
Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose:
The Molecular Diagnostics Medicare Medical Director at Palmetto GBA oversees medical staff, analyzes utilization data, research emerging molecular technologies, and serves as a resource for providers and internal teams on policy issues. The role also includes developing, writing, and revising medical policies to ensure compliance and support Medicare coverage decisions.
Description
 

Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ONSITE at our GPC location at 17 Technology Circle, Columbia, SC.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You'll Do:

  • Supports operations in the form of case review on both medical and regulatory matters. Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures.

  • Educates staff and medical community on various aspects of medical policy and program administration.

  • May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. Develops external relationships with the medical community and serves as liaison between these entities and the contractors.

  • Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization.

  • Conducts research into new or controversial medical procedures and technology.

To Qualify For This Position, You'll Need The Following:

  • Required Education: Doctorate degree Medical Doctor (MD) with current active license to practice medicine.

  • Required License and Certificate: Active state medical license and current board certification in a recognized specialty.

  • Required Work Experience: 5 years post graduate experience in direct patient care.

  • Required Skills and Abilities: Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills.Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others. Ability to work as a team member as well as a leader. Knowledge of medical and utilization review techniques.

  • Required Software: Microsoft Office Suite.

We Prefer That You Have The Following:

  • Molecular Genetic Pathology fellowship training.

  • Medicare experience.

  • Experience interpreting medical evidence.

  • Scientific training/Research experience with publication history in Molecular Diagnostics.

Our Comprehensive Benefits Package Includes The Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

  • Subsidized health plans, dental and vision coverage

  • 401k retirement savings plan with company match

  • Life Insurance

  • Paid Time Off (PTO)

  • On-site cafeterias and fitness centers in major locations

  • Education Assistance

  • Service Recognition

  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

Pay Range Information:

Range Minimum
$206,011.00

Range Midpoint
$309,767.00

Range Maximum
$413,523.00

Pay Transparency Statement:

Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilitiesand protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.comor call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's moreinformation.

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