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Work From Home Claims Examiner Jobs (NOW HIRING)

Western Growers

Claims Examiner I

Fresno, CA · On-site +1

$40K - $52K/yr

  • Medical

  • Dental

  • Vision

... work-from-home, in-office or hybrid options. With competitive compensation packages, premier ... Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and ...

Firstsource

Claims Examiner

$17/hr

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department ... This position may work onsite or remotely from home. Physical Demands The physical demands ...

Firstsource

Claims Examiner

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department ... This position may work onsite or remotely from home. Physical Demands The physical demands ...

Firstsource

Claims Examiner

$17/hr

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department ... This position may work onsite or remotely from home. Physical Demands The physical demands ...

Firstsource

Claims Examiner

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department ... This position may work onsite or remotely from home. Physical Demands The physical demands ...

Allcat Claims Service

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

OR · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

New York, NY · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

Los Angeles, CA · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

Minto, AK · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

Florida, NY · Remote

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

Allcat Claims Service

Claims Examiner

North East, PA · On-site +1

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Our experienced team and strong work ethic have helped build lasting relationships throughout the ... Flood Claims Examiner Location: Remote Department: Flood - Quality Assurance Primary Duties

RENFROE (Roster)

Residential Claims Examiner

... work from home or work from a centralized office • Regular attendance required, working up to 12 hours a day, 7 days a week, for extended periods of time, including weekends and holidays • ...

Gallagher

Claims Examiner

Oakland, CA · Remote

If you're ready to bring your unique perspective to a place where your work truly matters; think of ... At times, we will consider transferable skills from previous roles. Gallagher is an affirmative ...

Insperity

Medical Claims Examiner

Los Angeles, CA · On-site +1

$24 - $30/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

General information Client / Corporate Client Work Mode Hybrid Name Medical Claims Examiner Job ID 21986 City Chatsworth (Local Remote) Published date 07-Jul-2026 State California Country United ...

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Work From Home Claims Examiner information

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$15

$29

$45

How much do work from home claims examiner jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for work from home claims examiner in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What is a work from home claims examiner?

Work From Home Claims Examiners are professionals who review insurance claims to determine their validity and ensure compliance with policy terms, all while working remotely. They analyze claim forms, supporting documents, and sometimes communicate with claimants or medical professionals to gather additional information. These examiners may work for health, auto, property, or other types of insurance companies. Their remote role allows for flexibility, but requires strong attention to detail, confidentiality, and effective communication skills.

What does a work from home claims examiner do?

A work from home claims examiner is an insurance professional who works from a remote location outside of a traditional office. In this position, your responsibilities include evaluating insurance applications and claims as well as examining files submitted by an insurance adjuster. Your duties are to review submitted claims to understand coverage, ensure compliance with company policies and procedures, and help complete the process for a settlement. You may also work with other professionals on a large or complex case with a substantial payout to provide expertise and determine accuracy. You may find employment in a variety of insurance-related industries, including medical, automotive, and real estate.

What are the key skills and qualifications needed to thrive as a work from home claims examiner?

To excel as a Work From Home Claims Examiner, you need a solid understanding of insurance policies, claims processing, and attention to detail, often supported by a degree in business, finance, or a related field. Familiarity with claims management software, electronic documentation systems, and sometimes certifications like AIC (Associate in Claims) are typically required. Strong analytical thinking, self-motivation, and excellent written communication are crucial soft skills for remote collaboration and efficient case resolution. These competencies are vital for ensuring accurate, timely claim decisions and maintaining high standards of customer service from a remote environment.

How does a work from home claims examiner typically collaborate with other departments while working remotely?

As a Work From Home Claims Examiner, collaboration with other departments such as underwriting, customer service, and medical review teams is primarily conducted through digital communication platforms like email, instant messaging, and video conferencing. Regular virtual meetings and shared document systems help ensure accurate claims processing and timely resolution of issues. You'll often work closely with your supervisor and cross-functional teams to clarify claims details, escalate complex cases, and maintain consistent workflow. Effective remote communication and organization are key to successfully collaborating in this role.
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Work From Home Claims Examiner jobs near you
Infographic showing various Work From Home Claims Examiner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, and 4% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Examiner I

Western Growers

Fresno, CA • On-site, Remote

$40K - $52K/yr

Full-time

Medical, Dental, Vision

This job post has expired today. Applications are no longer accepted.

Job description

Ifyou'relooking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries,we'relooking for you.
At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides afull-suiteof comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.
As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background,historyand story that adds strength to our organization. Additionally, employees are encouraged to recognize that thereisn'ta work lifeanda home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee's life.One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.
With competitive compensation packages, premier investment support, enriching personaldevelopmentand more, we strive for our employees' job satisfaction and success.
Compensation:$40,580.28- $52,756.02with a rich benefits package that includes profit-sharing.
JOB DESCRIPTION SUMMARY
The Claims Examiner I reports to the Supervisor of Claims. Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation. The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plan, and other internal customers.
QUALIFICATIONS
High school education or equivalent: minimum three (3) to five (5) years of experience as a Health Claims Examiner or comparable industry experience preferred.
A minimum of one (1) year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims, highly desired.
Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination.
Basic knowledge of medical terminology. Familiar with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes.
Good verbal and written communication skills.
Proficient in 10-key by touch data entry/type 40 WPM and Microsoft Office (Word, Excel, Outlook, PowerPoint) and possess a capability to quickly learn new applications.
Ability to work under pressure and adapt to changing environment
Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims
processing/adjudication guidelines.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
A functioning smoke detector, fire extinguisher, and first aid kit on site.
DUTIES AND RESPONSIBILITIES
Claims Processing & Quality Assurance
Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, Blue Card, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe.
Analyze patient and medical records to identify instances where investigation for determining appropriate Claim Benefits, Pricing, Prior Authorization or Coordination of Benefits is necessary and process claims accordingly.
Examine claim files for accuracy: verifications (i.e. eligibility, medical authorization, etc.); reach out to Health Care Providers to obtain necessary claims documentation.
Research through all vendor portals, including but not limited to Valenz, Occunet, Anthem Resolve benefit and eligibility issues that require detailed knowledge, support for customers within the claims processing, Company and ERISA guidelines. Process low to medium level claims, re-pricing corrections.
Research, resolve and respond to all correspondence and internal communication (Ops Connect) related to electronic and paper claims as assigned.
Maintain a Health Insurance Portability and Accountability Act (HIPAA) compliant workstation. Utilize
appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
Meet and maintain individual and department productivity and quality standards.
Problem Solving, Judgement & Compliance
Examine a problem, set of data or text and consider multiple sides of an issue, weighs consequences before making a final decision.
Ensure compliance with all appropriate policies and practices, local, State, Federal regulations and requirements regarding claims and contract administration.
Partner with peers to document and analyze functional requirements, identify gaps and alternative approaches to resolve problems.
Contribute to defining and documenting standards and periodically reviewing them to integrate appropriate industry standards.
Alert supervisors to potential higher risk compliance issues.
Make timely and effective decisions based on available information
Recognize issues, analyzes, solves problems, researches, identifies trends and determines actions needed to advance the decision-making process within a realistic timeframe. Follows up as necessary.
Involve the appropriate people in defining, understanding the impact and resolving problems.
Other
Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
Maintain internet speed of 40MB download and 10MB upload and router with wired Ethernet.
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA[1]required protection of all confidential/protected client data.
Maintain and service safety equipment (e.g. smoke detector, fire extinguisher, first aid kit).
All other duties as assigned.
PHYSICAL DEMANDS / WORK ENVIRONMENT
The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

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