Remote Healthcare Claims Specialist

Remote Healthcare Claims Specialist Introduction: Championing Precision in Healthcare from Anywhere Are you ready to be at the forefront of transforming the healthcare landscape, all while working remotely? As a Remote Healthcare Claims Specialist, you will be vital in optimizing claims processing and reimbursement accuracy. Suppose you thrive in a data-intensive environment and love combining medical knowledge with cutting-edge claims systems. This position presents an ideal combination of innovation, autonomy, and purpose. You’ll join a digitally progressive team where each claim you handle is more than just a number—it’s a crucial step toward ensuring patients receive the care they deserve and providers are accurately reimbursed. With a salary of $52,562 annually, you can make a tangible impact from the comfort of your workspace. Key Responsibilities: Driving Accuracy with Every Claim Claims Evaluation & Adjudication • Review and process electronic and paper-based health insurance claims efficiently using claims adjudication platforms. • Validate codes (CPT, ICD-10, HCPCS) for accuracy and compliance with payer policies. • Investigate and resolve discrepancies in submitted documentation to ensure claim integrity. Coordination with Providers & Payers • Collaborate with healthcare providers and third-party payers to clarify claim details, resolve disputes, and secure timely payment. • Act as a liaison between medical professionals and billing systems to streamline communication and expedite claims resolution. Data Entry & Integrity Management • Accurately enter patient and claims data into claims management systems such as Epic, eClinicalWorks, or ClaimLogic. • Maintain meticulous records that align with HIPAA standards and payer-specific compliance requirements. Performance Metrics Monitoring • Track and analyze claim processing times, approval rates, and denial trends. • Use dashboards and visual data tools to identify patterns and propose operational improvements. Work Environment: Built for Focused Remote Success This fully remote position is designed for professionals who thrive in independently managed, performance-oriented settings. You’ll be immersed in a structured yet flexible virtual workspace with tools prioritizing data security, collaboration, and continuous learning. We cultivate a remote culture that values transparency, timely communication, and accountability. Expect regular virtual standups, performance reviews driven by key metrics, and real-time support via integrated communication channels like Slack and Microsoft Teams. Tools & Technology: Empowered by Innovation Our claims specialists are equipped with some of the most reliable and intuitive tech stacks in the healthcare reimbursement ecosystem: • Claims Software: ClaimX, Medisoft, eClinicalWorks • EDI & Clearinghouses: Availity, Office Ally • Automation & AI Tools: Robotic Process Automation (RPA) for repetitive tasks • Security Systems: Two-factor authentication, end-to-end encryption, and cloud-based HIPAA-compliant storage • Analytics Platforms: Tableau, Power BI, Excel macros for trend analysis and data visualization By streamlining tasks with intelligent systems, we enable you to spend more time analyzing data and less time chasing paperwork. Qualifications: Precision Meets Proficiency Educational Background • A college-level qualification such as an associate’s or bachelor’s degree in Health Information Management, Medical Billing, or a related field • Certification in Medical Coding (CPC, CCS-P) strongly preferred Professional Experience • Minimum of 2 years of experience processing healthcare claims, ideally in a remote capacity • Deep understanding of payer-specific billing requirements (e.g., Medicare, Medicaid, private insurers) Core Skills • Expertise in CPT, ICD-10, and HCPCS coding structures • Strong command over cloud-based claims processing systems • High attention to detail with a data-accuracy mindset • Excellent written and verbal communication for provider interaction • Strong self-management and the ability to prioritize tasks effectively are vital for remote work productivity What Sets You Apart You have the technical acumen of a coder and the investigative instincts of a forensic analyst. Your past success in claims processing shows speed and accuracy, with a demonstrated ability to reduce denials and improve first-pass claim approval rates. If you’ve ever helped reengineer a claims workflow or taught peers how to use a new platform more efficiently, you’re already a standout. Growth & Advancement: Build a Future in Digital Healthcare The healthcare claims industry is evolving rapidly, and so can you. Our organization champions internal growth, with career development paths into: • Remote Revenue Cycle Analyst • Compliance Auditing Specialist • Healthcare Data Reporting Lead • Telehealth Billing Operations Supervisor Upskilling programs, certifications reimbursement, and tech-centric mentorships will keep you ahead in a dynamic field driven by machine learning, data interoperability, and remote-first strategies. Why This Role Matters: Making Claims Human-Centric At its core, claims processing isn’t just about numbers—it’s about closing the loop between care delivered and compensation received. As a Remote Healthcare Claims Specialist, your work protects provider viability and ensures equitable treatment access across populations. Your remote contributions ripple outward, fostering healthcare equity and financial stability within our national system. You’re not just behind a screen; you’re behind more intelligent systems, faster resolutions, and better health outcomes. Start Processing a Better Tomorrow If you’re fueled by precision, empowered by technology, and inspired to contribute meaningfully in a remote healthcare environment, then now is the time to take your seat in the future of digital claims processing. and help us reimagine how accuracy, speed, and empathy can co-exist in every claim reviewed. Let’s build a more innovative, fairer healthcare system—one claim at a time. Careers Without Borders: We welcome applicants from the USA, Canada, UK, European Union, Australia, India, and many other global regions. Browse our Worldwide Hiring Coverage for more details. Apply tot his job Apply tot his job