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Remote Medicare Jobs in Rio Rancho, NM (NOW HIRING)

Onco360

Pharmacy Prior Authorization Specialist

Albuquerque, NM · Remote

$19.75 - $25.75/hr

Remote work if licensed in State of New Mexico. Why Join Us? * A career with purpose: Help patients ... Knowledge of pharmacy terminology, pharmacy insurance claims, Medicare, Medicaid, and commercial ...

Headway

Licensed Clinical Social Worker

Albuquerque, NM · On-site +1

$120/hr

... Remote or In-Person Flexible Schedule Pay & Flexibility * Hourly Rate: Up to $120 per hour ... Work with major plans, including Medicare Advantage and Medicaid. Provider Benefits * Rapid Growth:

InsuraTec

Sales Representative (Remote)

Rio Rancho, NM · Remote

Location: 100% Remote (Work From Home) About InsuraTec: InsuraTec is a leading provider in financial planning and insurance services. We're looking for driven individuals to join our team as Sales ...

InsuraTec

Sales Representative (Remote)

Los Lunas, NM · Remote

Location: 100% Remote (Work From Home) About InsuraTec: InsuraTec is a leading provider in financial planning and insurance services. We're looking for driven individuals to join our team as Sales ...

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Showing results 21-40

All JobsMedicare JobsRemote Medicare JobsRemote Medicare Jobs in Rio Rancho, NM

Remote Medicare information

See Rio Rancho, NM salary details

$16

$20

$22

How much do remote medicare jobs pay per hour?

As of Sep 15, 2026, the average hourly pay for remote medicare in Rio Rancho, NM is $20.22, according to ZipRecruiter salary data. Most workers in this role earn between $16.97 and $21.49 per hour, depending on experience, location, and employer.

What are remote Medicare jobs?

Remote Medicare jobs are positions that involve working with Medicare-related services or support, but can be performed from home or another remote location. These roles can include customer service representatives, claims processors, billing specialists, and case managers who assist Medicare beneficiaries, process claims, answer inquiries, and ensure compliance with Medicare regulations. Remote Medicare jobs are often offered by insurance companies, healthcare providers, or third-party administrators who serve the Medicare population. They typically require strong communication skills, knowledge of Medicare policies, and proficiency with digital tools to manage tasks and communicate with clients or team members. These jobs provide flexibility and the opportunity to help individuals navigate the Medicare system.

What are remote Medicare jobs?

Remote Medicare jobs entail the selling of health insurance, supplementary coverage, and other benefits to seniors who qualify for Medicare services. In these positions, you perform your duties as an employee or contractor who works outside of a company office. You contact seniors via phone or internet, and you may meet face-to-face to explain Medicare plan options and help with the enrollment process. You follow up on sales leads and work with customers who have an existing account to sell new products and benefits. Your responsibilities can focus on a specific type of medical coverage, such as home healthcare or prescription insurance plans.

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

To thrive as a Remote Medicare Specialist, you need a solid understanding of Medicare regulations, claims processing, and healthcare compliance, typically supported by experience in medical billing or coding and at least a high school diploma or equivalent. Familiarity with Medicare billing software, electronic health records (EHRs), and customer relationship management (CRM) systems is highly valued. Excellent communication, attention to detail, and problem-solving skills help professionals effectively assist clients and resolve complex inquiries remotely. These competencies ensure accurate claims processing, regulatory compliance, and strong client satisfaction in a virtual healthcare environment.

What are some common challenges faced by professionals working in remote Medicare roles, and how can they be addressed?

Professionals in remote Medicare positions often face challenges such as staying updated with frequent policy changes, ensuring HIPAA-compliant communication, and maintaining effective collaboration with team members and clients across different locations. To address these challenges, it's important to actively participate in ongoing training, use secure and reliable technology platforms, and establish regular check-ins with colleagues. Building strong communication habits and leveraging available digital tools can help remote employees stay connected and efficient in their roles.

What is the difference between Remote Medicare vs Remote Medicaid?

AspectRemote MedicareRemote Medicaid
Required CertificationsMedicare certification, health insurance licensesMedicaid certification, health insurance licenses
Work EnvironmentCall centers, insurance companies, healthcare providersCall centers, government agencies, healthcare providers
Industry UsagePrivate insurers, Medicare Advantage plansState Medicaid programs, government agencies
Common Search/ComparisonRemote Medicare vs Remote Medicaid

Remote Medicare and Remote Medicaid roles both involve assisting beneficiaries with insurance plans, but they differ mainly in certification requirements and employer types. Medicare roles focus on private insurance plans for seniors, while Medicaid roles are linked to government-funded programs for low-income populations. Understanding these differences helps job seekers target the right opportunities in the healthcare insurance industry.

More about Remote Medicare jobs

What are the most commonly searched types of Medicare jobs in Rio Rancho, NM?

The most popular types of Medicare jobs in Rio Rancho, NM are:

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

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

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

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

Infographic showing various Remote Medicare job openings in Rio Rancho, NM as of August 2026, with employment types broken down into 3% As Needed, 77% Full Time, 15% Part Time, and 5% Contract. Highlights an 88% Physical, 2% Hybrid, and 10% Remote job distribution, with an average salary of $42,067 per year, or $20.2 per hour.

Client Audit Specialist (PBM) - Remote

Albuquerque, NM • On-site, Remote

Prime Therapeutics LLC
Insurance Services • 1 - 5K employees
Learn more about Prime Therapeutics LLCexternal

Full-time

Posted 28 days ago

Key responsibilities

  • Manage regulatory and/or client-initiated audits by evaluating audit requests, determining scope, and managing end-to-end audit activities.

  • Develop and maintain relationships with internal and external stakeholders to provide audit consultation, ensure timely completion, and communicate audit results.

  • Monitor audit progress, identify and mitigate risks, perform quality reviews of audit deliverables, and prepare documentation for audit activities.

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

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
Client Audit Specialist (PBM) - RemoteJob Description
As a member of the Client Audit Management (CAM) team, the Client Audit Specialist is accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is responsible for evaluating and understanding the purpose of various audit types and the related deliverables, developing a holistic understanding of the audit management process, and managing the end-to-end audit activities. This position seeks and obtains additional expertise as indicated from respective Compliance and Operational subject matter experts to meet applicable regulatory, client, and/or functional audit expectations.
Responsibilities
  • Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request
  • Present sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implications
  • Develop and maintain key internal and external stakeholder relationships to effectively provide audit consultation, streamline work activity, create/drive efficiencies, and ensure consistent, timely, and accurate audit completion, reporting, or submission of deliverables
  • Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to Audit Advisors, department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings
  • Perform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirements
  • Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes
  • Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders
  • Integrate project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, throughout the entire audit
  • Support department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained
  • Other duties as assigned

Minimum Qualifications
  • Bachelor's degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED is required
  • 2 years of relevant work experience in audit, compliance or operations within a regulated environment

Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
  • Effective verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings
  • Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities
  • Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy
  • Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
  • Agility and adaptability to change and navigate in a demanding, dynamic, fast-paced, intense, and matrix environment
  • Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence
  • Intermediate to Advanced skills in Microsoft Office Suite (Word, Excel)

Preferred Qualifications
  • Health insurance/PBM operations and/or contract audit experience
  • Experience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefit
  • Project management experience

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 $66,000.00 - $106,000.00 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.

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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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