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Remote Medicare Claims Processing Jobs (NOW HIRING)

Firstsource

Claims Examiner

$17 - $20/hr

United States (Remote) Employment Type: Full-Time Experience Required: Minimum 2 years in US Health ... are claims processing and Appeals & Grievances. * Knowledge of commercial, Medicare, and/or ...

Firstsource

Claims Examiner

$17 - $20/hr

United States (Remote) Employment Type: Full-Time Experience Required: Minimum 2 years in US Health ... are claims processing and Appeals & Grievances. * Knowledge of commercial, Medicare, and/or ...

IQVIA

Medical Biller/Claims Processing

Phoenix, AZ · Remote

$23/hr

Patient SupportMedicalBillingRepresentative Contract Remote Role - Location (Open to Remote US) At ... Evaluate claims against program-specific business rules todetermineapproval or rejection.

Lancesoft - Viren

Be Seen First

Healthcare - Appeals Specialist I

The Woodlands, TX · Remote

$19.92 - $21.92/hr

Remote, CANDIDATES MUST LIVE IN ONE OF THE PREFFERED 15 STATES (AZ, FL, GA, ID, IA, KY, MI, MS, NE ... and Medicare claims denials and appeals processing, and knowledge of regulatory guidelines for ...

Amerita

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

Peraton

Cobol Software Developer

$66K - $106K/yr

Responsibilities The Peraton Health, State and Local Sector is seeking a Software Development, Senior Associate to join us in supporting and maintaining the Medicare Fee for Service claims processing ...

IQVIA

Medical Biller/Claims Processing

Atlanta, GA · Remote

$23/hr

Patient SupportMedicalBillingRepresentative Contract Remote Role - Location (Open to Remote US) At ... Evaluate claims against program-specific business rules todetermineapproval or rejection.

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

JNR Adjustment Company, Inc

Claims Representative

As a Remote Claims Representative, you will be responsible for investigating, evaluating, and ... Strong knowledge of property and auto claims processes and regulations * Excellent communication ...

PharMerica

Pharmacy Claims Processor / Remote

Louisville, KY · On-site +1

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

BrightSpring

Pharmacy Claims Processor / Remote

Louisville, KY · Remote

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

BrightSpring

Pharmacy Claims Processor / Remote

Louisville, KY · Remote

$15.50 - $19.75/hr

Researches, analyzes and appropriately resolves rejected claims by working with national Medicare D ... Prepares and maintains reports and records for processing * Performs other tasks as assigned ...

Spotter

Spotter AI is on the lookout for a dedicated and detail-oriented Claims Specialist to enhance our claims processing team. This remote position is vital in ensuring that our clients receive prompt and ...

Fortuna BMC

Remote Medicare Call Center Agent

$18/hr

Remote Medicare Call Center Agent Join Fortuna as a full-time Medi-Cal Call Center Agent ... claims, benefits, eligibility, authorizations, provider services, or other healthcare support.

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Remote Medicare Claims Processing information

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$12

$22

$34

How much do remote medicare claims processing jobs pay per hour?

As of Aug 18, 2026, the average hourly pay for remote medicare claims processing in the United States is $22.34, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $25.48 per hour, depending on experience, location, and employer.

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.

More about Remote Medicare Claims Processing jobs

What cities are hiring for Remote Medicare Claims Processing jobs?

Cities with the most Remote Medicare Claims Processing job openings:

What are the most commonly searched types of Medicare Claims Processing jobs?

The most popular types of Medicare Claims Processing jobs are:

What states have the most Remote Medicare Claims Processing jobs?

States with the most job openings for Remote Medicare Claims Processing jobs include:

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

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

Remote Medicare Claims Processing jobs near you
Infographic showing various Remote Medicare Claims Processing job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $46,461 per year, or $22.3 per hour.

Claims Examiner

Firstsource

Remote

$17 - $20/hr

Full-time

Medical

Re-posted 12 days ago

Firstsource rating

6.5

Company rating: 6.5 out of 10

Based on 57 frontline employees who took The Breakroom Quiz

28th of 71 rated call and contact centers

Job description

Job Description: Claims & Appeals & Grievances (A&G) Specialist - Back Office Operations
Job Title: Claims & Appeals & Grievances (A&G) Specialist
Department: Healthcare Operations
Location: United States (Remote)
Employment Type: Full-Time
Experience Required: Minimum 2 years in US Healthcare Back Office Operations
Pay Range: $17-$20 (based on your experience)
Position Overview
We are seeking a highly organized and detail-oriented Claims & Appeals & Grievances (A&G) Specialist to join our Healthcare Operations team. The ideal candidate will have a minimum of two years of experience supporting US healthcare back-office operations with expertise in claims processing, appeals, grievances, and administrative support functions.
This role is responsible for reviewing and processing healthcare claims, researching and resolving claim-related issues, coordinating appeals and grievance activities, ensuring compliance with regulatory requirements, and maintaining accurate documentation. The successful candidate will demonstrate strong analytical skills, attention to detail, and the ability to work efficiently in a fast-paced, quality-driven environment.
Key Responsibilities
Claims Operations
  • Review, validate, and process medical, behavioral health, and pharmacy claims in accordance with health plan policies and established business rules.
  • Perform claim research to identify discrepancies, missing information, eligibility concerns, authorization requirements, and benefit coverage issues.
  • Verify member eligibility, provider information, coding accuracy, and supporting documentation prior to claim adjudication or escalation.
  • Analyze suspended, pending, denied, or rejected claims and determine appropriate next steps.
  • Ensure claims are processed accurately within established turnaround times and service level agreements (SLAs).
  • Document all actions, findings, and resolutions within the claims management system.

Appeals & Grievances
  • Receive, review, and process member and provider appeals and grievances in accordance with CMS, state, federal, and organizational requirements.
  • Research claim history, medical records, benefit plans, provider contracts, and supporting documentation to determine appropriate case resolution.
  • Coordinate with internal clinical, compliance, provider services, customer service, and operations teams to obtain additional information when required.
  • Prepare case summaries, correspondence, and resolution documentation while ensuring completeness and accuracy.
  • Track appeal and grievance cases from receipt through final resolution while meeting regulatory turnaround time requirements.
  • Escalate complex or high-risk cases to appropriate departments as necessary.

Back Office Operations
  • Perform data entry, record maintenance, document indexing, and quality validation activities.
  • Maintain confidentiality of Protected Health Information (PHI) in accordance with HIPAA regulations.
  • Review operational reports and work queues to prioritize daily workload.
  • Identify processing errors, trends, or recurring issues and recommend corrective actions.
  • Participate in quality audits, process reviews, and continuous improvement initiatives.
  • Support cross-functional operational projects and departmental objectives.

Compliance & Quality
  • Adhere to CMS, HIPAA, NCQA, and internal compliance standards.
  • Ensure all documentation is complete, accurate, and audit-ready.
  • Meet departmental productivity, quality, accuracy, and turnaround time metrics.
  • Participate in required compliance, privacy, and operational training programs.
  • Maintain current knowledge of healthcare regulations, benefit plans, and organizational policies.

Required Qualifications
  • High School Diploma or GED required; Associate's or Bachelor's degree preferred.
  • Minimum of 2 years of experience in US Healthcare Back Office Operations.
  • Experience in healthcare claims processing and Appeals & Grievances.
  • Knowledge of commercial, Medicare, and/or Medicaid health plans.
  • Understanding of medical terminology, healthcare benefits, and claim workflows.
  • Familiarity with CPT, ICD-10-CM, HCPCS, and healthcare documentation.
  • Experience working with claims processing systems, workflow management tools, and electronic document management systems.
  • Proficiency with Microsoft Office, including Excel, Word, and Outlook.
  • Strong written and verbal communication skills.
  • Excellent analytical, organizational, and problem-solving abilities.

Preferred Qualifications
  • Experience in Managed Care, Health Insurance, Third-Party Administration (TPA), or Healthcare Business Process Outsourcing (BPO).
  • Knowledge of healthcare regulations governing appeals and grievance processes.
  • Experience handling high-volume production environments.
  • Familiarity with quality assurance processes and operational audits.

Core Competencies
  • Claims Processing
  • Appeals & Grievance Administration
  • Claims Investigation
  • Healthcare Documentation Review
  • Data Validation & Quality Assurance
  • Regulatory Compliance
  • HIPAA Compliance
  • Medicare & Medicaid Guidelines
  • Medical Terminology
  • Attention to Detail
  • Critical Thinking
  • Time Management
  • Customer Focus
  • Team Collaboration
  • Problem Solving

Performance Expectations
  • Achieve established productivity and quality targets.
  • Meet appeal and grievance turnaround time requirements.
  • Maintain high claims processing accuracy.
  • Ensure timely completion of assigned work queues.
  • Demonstrate compliance with HIPAA, CMS, and organizational policies.
  • Contribute to continuous process improvement initiatives.
  • Maintain positive collaboration with internal stakeholders and support teams.

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