Remote Health Insurance Claims Processor

Location: Fully Remote | United States-Based Applicants Only
Salary: $46,461 Annually
Schedule: Full-Time | Flexible Hours | Monday through Friday

Introduction to a Future-Focused Career in Remote Healthcare

Join a fast-evolving remote healthcare network at the forefront of digital claims innovation. We are searching for a Remote Health Insurance Claims Processor who thrives in a data-centric, tech-enabled environment. This role is more than just reviewing documents—it's about shaping the future of health claims automation and providing real-time value to providers and patients nationwide.

Working from home doesn’t mean working alone. Our remote-first culture prioritizes digital collaboration and performance transparency, giving you the autonomy you crave with the structure you need. You’ll be part of a team committed to precision, speed, and a seamless healthcare experience.

Key Responsibilities for the Remote Claims Processor Role

Claims Management and Accuracy

You will play a critical role in the accurate and timely processing of healthcare claims. This includes verifying claim details against health plan policies, ensuring proper coding with CPT, ICD-10, and HCPCS standards, and preventing costly administrative errors.

• Review and process an average of 120+ claims weekly
• Validate medical procedure codes and billing amounts
• Ensure claims comply with payer policies and regulations

Digital Data Entry and Documentation

Data entry accuracy is non-negotiable. Leveraging our cloud-based claims management system, you’ll enter and validate information with 99% accuracy, a key metric in maintaining our service level agreements (SLAs) with partners.

• Input claims data into proprietary platforms with minimal error rates
• Maintain comprehensive digital documentation for audit-readiness
• Flag incomplete claims for resolution and follow-up

Risk Detection and Escalation

Using AI-assisted workflows, you will monitor for unusual patterns, helping prevent fraudulent claims and reducing financial waste in the system.

• Utilize ClaimPath AI to identify anomalies in claims data
• Escalate suspicious activities to the compliance and investigations teams
• Document escalation rationale with supporting evidence

Cross-Functional Collaboration

You’ll work closely with departments such as medical review, compliance, and provider relations. Seamless communication will ensure fast issue resolution and an improved claims cycle.

• Communicate with internal departments to resolve claim disputes
• Participate in case reviews and process debriefs
• Collaborate via Slack and Jira for task tracking and updates

Compliance and Audit Preparation

Adherence to healthcare regulations is fundamental to maintaining operational excellence. You’ll ensure that all processed claims meet state and federal health regulations and internal quality standards.

• Prepare claims for external and internal audits
• Align documentation practices with HIPAA standards
• Support monthly compliance reviews and feedback sessions

Tools and Technology Empowering Your Success

Claims Automation and Machine Learning Tools

You’ll be equipped with the latest in health tech innovation. Our in-house ClaimPath AI system assists in reviewing high volumes of claims efficiently while identifying data outliers and potential issues.

• Automated claim flagging for anomalies
• Predictive analytics for turnaround time estimation

Workflow and Project Management Platforms

Efficiency is enhanced through integrated platforms like Jira for sprint management and HealthFlow Dashboard for real-time workflow insights.

• Prioritize claims based on real-time queues.
• Communicate task statuses with minimal manual updates

Data Integration and Visualization

We integrate with over 120 EHR systems through SecureCloud EHR Sync, ensuring real-time access to patient data and supporting informed claims processing.

• Visualize processing trends using Power BI and Tableau
• Leverage dashboard insights to improve daily performance

Remote Work Environment and Team Culture

Flexible and Independent Work Culture

Enjoy the freedom to design your workday around your most productive hours. Our remote-first approach is anchored in trust and results, not micromanagement.

• No mandatory video calls—efficiency is key.
• Daily asynchronous check-ins for progress tracking

Employee Experience and Engagement

We care about our team’s well-being. We foster community in the digital workspace with regular wellness challenges, virtual coffee chats, and optional learning sessions.

• Monthly challenges focused on physical and mental health
• Peer recognition awards and spotlight features

Performance Transparency and Recognition

Growth is based on measurable performance. Our quarterly reviews are built on data, giving you a clear view of your progress and areas for advancement.

• Real-time KPIs are available through employee dashboards
• Transparent promotion criteria and career mapping

Qualifications and Required Skills

Essential Experience and Knowledge

We’re seeking professionals with demonstrated excellence in health claims processing and a passion for operational integrity.

• Minimum 2 years of experience in healthcare billing or claims
• Strong command of CPT, ICD-10, and HCPCS codes
• Comfortable navigating cloud-based systems securely

Technical and Communication Proficiency

This role requires technological fluency and practical communication skills, especially in a remote context.

• Ability to explain complex claims issues clearly in writing
• Skilled in using collaboration tools like Slack, Notion, and Zoom

Preferred but Not Required

Candidates with the following will stand out, though we value aptitude and drive above all:

• Remote work experience
• HIPAA and data privacy knowledge
• Industry-recognized certification in billing or coding

Success Metrics and Career Progression

First 30 Days: Training and Onboarding

• Complete structured onboarding with hands-on platform practice
• Pass knowledge quizzes with 90 %+ accuracy
• Shadow senior team members for process immersion

First 90 Days: Accuracy and Contribution

• Independently process claims with 99% accuracy
• Participate in feedback loops to refine internal SOPs
• Share insights on system usability improvements

First 6 Months: Leadership and Optimization

• Lead a task force to improve claims cycle efficiency by 10%
• Present performance findings to team leads
• Mentor one or more new hires based on metrics and availability

Career Growth and Long-Term Opportunities

Advancement Paths Within the Organization

We believe in promoting from within and have clear advancement tracks based on performance, initiative, and collaboration.

• Pathway to Senior Claims Analyst within 12-18 months
• Opportunities in Health Data QA, Analytics, or Automation Development
• Option to join internal innovation labs for product feedback and testing

Call to Action: Apply for a Role That Drives Healthcare Innovation

You deserve a role where your expertise makes a difference. As a Remote Health Insurance Claims Processor, you’ll contribute to a more agile, accurate, and patient-centric healthcare experience from wherever you are.

If you’re ready to join a tech-driven team that values data, trust, and performance, we invite you to apply today. Let’s reimagine the future of health claims together.

Apply now and take the next step in your remote healthcare journey.