Remote Health Insurance Claims Examiner

Introduction: Shape the Future of Healthcare—From Anywhere

Are you ready to make a meaningful impact in the healthcare industry while enjoying the flexibility of a remote work environment? As a Remote Health Insurance Claims Examiner, you will serve an essential function in maintaining the accuracy and fairness of healthcare services while supporting members through timely, accurate, and compassionate claims processing. This is more than just a job—it’s an opportunity to contribute nationwide to individuals' and families' financial and emotional well-being.

With an annual salary of $64,609, this position offers a compelling blend of professional growth, purpose-driven work, and work-life balance.

Role, Purpose, and Mission

Your Core Responsibilities

As a Health Insurance Claims Examiner working remotely, your primary task is to evaluate and process insurance claims following regulatory guidelines and internal policies. Your work ensures members are reimbursed appropriately and providers receive dependable support.

This role drives our dedication to providing inclusive, streamlined, and impactful healthcare support. You’re not just managing documents but reinforcing trust within a complex healthcare landscape.

Key Responsibilities and Duties

Claims Review and Adjudication

• Examine health insurance claims for accuracy, completeness, and eligibility.
• Determine claim payment or denial based on medical necessity, policy coverage, and benefit plans.
• Use standard industry codes, including ICD-10, CPT, and HCPCS for accurate claim assessment.

Communication and Collaboration

• Discuss claim-related inquiries with healthcare providers, patients, and internal teams.
• Provide detailed feedback or requests for additional documentation when needed.

Compliance and Documentation

• Ensure all claim reviews comply with HIPAA, state, and federal guidelines.
• Maintain precise records and document claim decisions in internal audit and quality control systems.

Quality Improvement

• Identify trends in claims processing errors and work with leadership to improve operational processes.
• Participate in ongoing training programs and peer reviews to enhance professional development.

Importance and Impact of This Role

Contributing to Healthcare Integrity

Every claim you process influences someone’s well-being. Whether it’s a family seeking reimbursement after an essential procedure or a provider depending on timely payments, your role shapes outcomes across the healthcare journey.

You’ll help drive financial accuracy, member satisfaction, and our mission to improve healthcare service delivery. Your contributions foster trust, consistency, and efficiency in an evolving healthcare environment.

Remote Work Environment and Culture

Work Flexibility and Digital Tools

This 100% remote claims examiner role allows you to contribute meaningfully from wherever you are. We provide all necessary equipment and a comprehensive orientation experience that helps you quickly integrate into our remote systems.

You’ll join a team that thrives on collaboration through digital tools, virtual check-ins, and continuous professional development. We believe in empowering each team member to thrive autonomously while staying aligned with team objectives.

Technology and Tools Utilized

Claims Processing and Communication Systems

• Claims Management Software (e.g., Facets, QNXT, or similar)
• Medical coding systems (ICD-10, CPT, HCPCS)
• Microsoft Office Suite (Outlook, Excel, Word)
• Secure communication platforms (e.g., Zoom, Teams, Slack)
• Electronic health record (EHR) and document management systems

Required and Preferred Qualifications

Essential Qualifications

• 2+ years of experience as a health insurance claims examiner, medical billing specialist, or related role.
• Strong understanding of insurance guidelines, benefit plans, and claims adjudication processes.
• Proficiency in interpreting medical codes (ICD-10, CPT, HCPCS).
• Excellent written and verbal communication skills.
• Exceptional precision in handling data and efficient task organization.
• Demonstrated capability to manage tasks with minimal supervision.

Desirable Credentials and Experience

• Official accreditation in medical coding, such as AHIMA or AAPC certifications.
• Familiarity with Medicare/Medicaid guidelines.
• Experience working in a high-volume, remote healthcare operations setting.

Professional Development and Career Growth

Advancement Opportunities

This role is structured to encourage both immediate success and continuous development. By joining us, you'll gain:

• Access to certified training programs designed to expand your expertise.
• Opportunities to pursue leadership roles in supervisory and audit functions.
• The ability to explore new career paths within other health insurance operations.
• Personalized mentorship from experienced professionals committed to your advancement.

We actively recognize progress and promote growth. This role offers a strong foundation if you're proactive, detail-oriented, and ready to build a future in healthcare operations.

Performance Expectations

Metrics for Success

You will know you're succeeding when:

• Claims are processed with consistent accuracy and timeliness.
• Internal audits reflect high compliance standards.
• Providers and members feel confident in your decision-making.
• You actively contribute ideas that enhance operational efficiency and service quality.
• You feel empowered, challenged, and appreciated in your daily work.

Join Us: Apply Today

Take the Next Step in Your Career

Imagine using your expertise to support families, clarify medical decisions, and bring peace of mind to providers—all from the comfort of your home. Your skills, insight, and commitment make a difference in this role.

We are looking for individuals who are not only highly competent but deeply compassionate. If you're ready to bring your knowledge to a place that values empathy as much as excellence, we encourage you to begin your journey with us.

Submit Your Application

This is your chance to transform the way you work and the impact you have. Seize this opportunity to start your next chapter as a Remote Health Insurance Claims Examiner.

Empower yourself. Enrich others. Evolve your future.