Remote Claims Operations Manager Jobs
Remote claims operations manager jobs are open across insurance carriers, third-party administrators, and managed care organizations in the U.S., from mid-level operations roles at distributed teams to senior leadership positions overseeing remote claims units. Employers hiring remotely right now include Allianz, CareSource, and My Claim Warrior. Scan the live roles below and apply to whichever ones fit.
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Supports data collection/interpretation by reviewing routine and non-routine data in claims databases, using working knowledge of KP systems. Following general instructions to collect medical data, validate medical coverage, and verify details in referral requests and/or authorizations and conduct an in-depth review of audit work, in accordance to policies and procedures. Acts in compliance with KP policies by informally mentoring others on compliance policy and maintaining working knowledge of relevant compliance standards, regulatory policies, laws, or accreditation standards. Follows general instructions to complete tasks during strategic projects and provides recommendations to improve specific process/system issues according to a variety of project metrics. Supports member identification/support processes by obtaining and providing uncommon information related to claims-payment issues and communicates with cross-team peers to understand resolutions that should be proposed to providers and members.
Essential Responsibilities:
- Pursues effective peer relationships within and across teams to obtain and share resources and information. Listens to, addresses, and seeks performance feedback; acts as an informal resource for less experienced team members. Actively seeks new relevant knowledge and skills based on strengths and weaknesses; reviews others work to help others learn. Adapts to change, challenges, and feedback with minimal guidance; demonstrates flexibility in work. Assesses and responds to the needs of others to support completion of work tasks.
- Follows instructions to complete routine and non-routine work assignments with limited supervision. Collaborates with others to recommend appropriate solutions for routine and non-routine issues; escalates complex issues; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities within ones team.
- Supports the payment of claims as directed by: using judgement when gathering information to ensure that all expenditures are reviewed and paid on time in accordance with appropriate benefits and internal protocols with some support; and communicating with claims adjudicators and vendors to provide claims information (e.g. pay decisions, clinical determinations, referral matching) back to adjudicators on payment approval/denial, under a limited degree of supervision.
- Acts in compliance with KP policies by: completing routine and non-routine tasks according to policies and procedures that support compliant work, under minimal guidance; conducting an in-depth review of work, providing feedback, and acting as an informal resource to ensure work is completed according to relevant documentation, policies, and processes related to referrals, authorization processes, utilization review; and utilizing working knowledge of relevant claims processing to identify relevant compliance standards, regulatory policies, laws, or accreditation standards that should be incorporated into compliance training.
- Supports data collection/interpretation as directed by: utilizing working knowledge of database technologies to review and flag common and uncommon database issues related to system configurations and testing changes; conducting routine and non-routine data and documentation tasks to ensure the accuracy of claims details in claims databases across various regions; and following relevant processes and procedures to maintain database workflows.
- Supports member identification/support processes as directed by: obtaining and reviewing uncommon information from cross-team peers to help resolve claims-payment issues or provider disputes; and communicating with cross-team peers to understand resolutions that should be proposed to providers and members when addressing claims and benefits inquiries.
- Contributes to improvements to operations and technology processes by: gathering data on routine and non-routine billing errors and identifying problems with claims, referrals, or other system processes; and reviewing a variety of project metrics to monitor the success of strategic improvement projects.
Knowledge, Skills and Abilities: (Core)
- Ambiguity/Uncertainty Management
- Attention to Detail
- Business Knowledge
- Communication
- Critical Thinking
- Cross-Group Collaboration
- Decision Making
- Dependability
- Diversity, Equity, and Inclusion Support
- Drives Results
- Facilitation Skills
- Health Care Industry
- Influencing Others
- Integrity
- Learning Agility
- Organizational Savvy
- Problem Solving
- Short- and Long-term Learning & Recall
- Teamwork
- Topic-Specific Communication
Knowledge, Skills and Abilities: (Functional)
- Claims Applications
- Computer Literacy
- Contract Review & Claims Validation
- Customer Experience
- Data Entry
- Health Insurance Products
- Insurance
- Insurance Coding
- Insurance Regulations, Policies, and Procedures
Minimum Qualifications:
- Minimum one (1) year of experience in referral experience which could be: Referral Services, Claims Membership, Claims Referral Processing, Authorization/Referral Claims Administration or a directly related field.
- High School Diploma or GED, or equivalent AND minimum two (2) years of experience working in a corporate or business office environment OR Minimum three (3) years of experience working in a corporate or business office environment.
Preferred Qualifications:
PrimaryLocation : Nevada,Reno,Reno Professional Circle Administration
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NV-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Insurance
Department : Reno 10315 Professional Cir - Mbrshp Acctg-Grp Bllng - 3841
Travel : Yes, 15 % of the Time
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
Supports data collection/interpretation by reviewing routine and non-routine data in claims databases, using working knowledge of KP systems. Following general instructions to collect medical data, validate medical coverage, and verify details in referral requests and/or authorizations and conduct an in-depth review of audit work, in accordance to policies and procedures. Acts in compliance with KP policies by informally mentoring others on compliance policy and maintaining working knowledge of relevant compliance standards, regulatory policies, laws, or accreditation standards. Follows general instructions to complete tasks during strategic projects and provides recommendations to improve specific process/system issues according to a variety of project metrics. Supports member identification/support processes by obtaining and providing uncommon information related to claims-payment issues and communicates with cross-team peers to understand resolutions that should be proposed to providers and members.
Essential Responsibilities:
- Pursues effective peer relationships within and across teams to obtain and share resources and information. Listens to, addresses, and seeks performance feedback; acts as an informal resource for less experienced team members. Actively seeks new relevant knowledge and skills based on strengths and weaknesses; reviews others work to help others learn. Adapts to change, challenges, and feedback with minimal guidance; demonstrates flexibility in work. Assesses and responds to the needs of others to support completion of work tasks.
- Follows instructions to complete routine and non-routine work assignments with limited supervision. Collaborates with others to recommend appropriate solutions for routine and non-routine issues; escalates complex issues; communicates progress and information. Supports the completion of priorities, deadlines, and expectations. Identifies and speaks up for ways to address improvement opportunities within ones team.
- Supports the payment of claims as directed by: using judgement when gathering information to ensure that all expenditures are reviewed and paid on time in accordance with appropriate benefits and internal protocols with some support; and communicating with claims adjudicators and vendors to provide claims information (e.g. pay decisions, clinical determinations, referral matching) back to adjudicators on payment approval/denial, under a limited degree of supervision.
- Acts in compliance with KP policies by: completing routine and non-routine tasks according to policies and procedures that support compliant work, under minimal guidance; conducting an in-depth review of work, providing feedback, and acting as an informal resource to ensure work is completed according to relevant documentation, policies, and processes related to referrals, authorization processes, utilization review; and utilizing working knowledge of relevant claims processing to identify relevant compliance standards, regulatory policies, laws, or accreditation standards that should be incorporated into compliance training.
- Supports data collection/interpretation as directed by: utilizing working knowledge of database technologies to review and flag common and uncommon database issues related to system configurations and testing changes; conducting routine and non-routine data and documentation tasks to ensure the accuracy of claims details in claims databases across various regions; and following relevant processes and procedures to maintain database workflows.
- Supports member identification/support processes as directed by: obtaining and reviewing uncommon information from cross-team peers to help resolve claims-payment issues or provider disputes; and communicating with cross-team peers to understand resolutions that should be proposed to providers and members when addressing claims and benefits inquiries.
- Contributes to improvements to operations and technology processes by: gathering data on routine and non-routine billing errors and identifying problems with claims, referrals, or other system processes; and reviewing a variety of project metrics to monitor the success of strategic improvement projects.
Knowledge, Skills and Abilities: (Core)
- Ambiguity/Uncertainty Management
- Attention to Detail
- Business Knowledge
- Communication
- Critical Thinking
- Cross-Group Collaboration
- Decision Making
- Dependability
- Diversity, Equity, and Inclusion Support
- Drives Results
- Facilitation Skills
- Health Care Industry
- Influencing Others
- Integrity
- Learning Agility
- Organizational Savvy
- Problem Solving
- Short- and Long-term Learning & Recall
- Teamwork
- Topic-Specific Communication
Knowledge, Skills and Abilities: (Functional)
- Claims Applications
- Computer Literacy
- Contract Review & Claims Validation
- Customer Experience
- Data Entry
- Health Insurance Products
- Insurance
- Insurance Coding
- Insurance Regulations, Policies, and Procedures
Minimum Qualifications:
- Minimum one (1) year of experience in referral experience which could be: Referral Services, Claims Membership, Claims Referral Processing, Authorization/Referral Claims Administration or a directly related field.
- High School Diploma or GED, or equivalent AND minimum two (2) years of experience working in a corporate or business office environment OR Minimum three (3) years of experience working in a corporate or business office environment.
Preferred Qualifications:
PrimaryLocation : Nevada,Reno,Reno Professional Circle Administration
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-NV-01|NUE|Non Union Employee
Job Level : Individual Contributor
Job Category : Insurance
Department : Reno 10315 Professional Cir - Mbrshp Acctg-Grp Bllng - 3841
Travel : Yes, 15 % of the Time
Kaiser Permanente is an equal opportunity employer committed to fair, respectful, and inclusive workplaces. Applicants will be considered for employment without regard to race, religion, sex, age, national origin, disability, veteran status, or any other protected characteristic or status.
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Find JobsRemote Claims Operations Manager Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote claims operations manager jobs.
- Five or more years of claims handling or claims operations experience
- Prior supervisory or management experience leading claims teams
- Proficiency with claims management systems such as Guidewire or similar platforms
- Working knowledge of insurance regulations and state-specific compliance requirements
- Experience managing KPIs such as cycle time, severity, and customer satisfaction scores
- Property and casualty adjuster license or willingness to obtain one
Tips for Your Remote Claims Operations Manager Job Search
Prove your async communication skills upfront
Remote claims operations managers coordinate adjusters, vendors, and compliance teams without face-to-face contact. Include examples of written escalation protocols, async status reporting, or documentation systems you built or improved. Hiring managers for remote roles weight this heavily.
Highlight claims platform proficiency on your resume
Remote employers can't watch you work, so naming the specific claims management and workflow platforms you've used, such as Guidewire, Duck Creek, or HealthEdge, signals immediately that you can operate independently from day one.
Apply early to remote roles that fit
Migrate Mate lists remote claims operations manager openings from across the U.S. in one place, so you can find roles that match your background and apply directly without sorting through location-filtered results.
Prepare for remote operational scenario interviews
Remote claims operations interviews often include scenarios about managing team performance or resolving bottlenecks without in-person oversight. Rehearse specific examples where you identified a process gap, acted on it remotely, and measured the outcome.
Remote Claims Operations Manager Jobs: Frequently Asked Questions
How do I get a remote claims operations manager job?
Target insurance carriers, third-party administrators, and managed care organizations that run distributed claims teams, as these employers are most likely to hire claims operations managers fully remote. Remote employers screen for self-direction, clear written communication, and demonstrated proficiency with claims management platforms and workflow tools. Showing measurable results from past claims operations work, such as cycle time reductions or accuracy improvements, gives you a strong edge over candidates without documented outcomes.
Which companies hire remote claims operations managers?
Employers currently hiring remote claims operations managers include Allianz, CareSource, and My Claim Warrior, per current remote listings on Migrate Mate as of November 2026. These tend to be insurance carriers, third-party administrators, and health plan administrators that operate distributed claims teams across multiple states.
Can you get a remote claims operations manager job with no experience?
Yes, but remote entry-level claims operations roles are harder to land because employers expect you to manage workflows and troubleshoot independently without on-site support. Your best path is through insurtech startups or smaller third-party administrators that hire junior operations staff remotely. Demonstrating familiarity with claims software, strong written communication, and any process improvement project, even from an adjacent role, can open the door.
Do you need a degree for remote claims operations manager jobs?
Not always. Many remote employers care more about hands-on claims operations experience, proficiency with claims platforms, and a clear history of managing or improving claims workflows than they do about a specific degree. Industry certifications in claims handling or healthcare operations can carry real weight, particularly at organizations that value demonstrated competency over formal credentials.
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