Remote Claims Operations Specialist Jobs
Remote claims operations specialist jobs are open across the U.S. at insurance carriers, third-party administrators, and health tech companies running distributed teams, with demand active in insurance, healthcare, and financial services. Employers hiring remotely right now include Allianz, CareSource, and My Claim Warrior. Find a role that fits below and apply directly.
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Showing 5 of 9+ Remote Claims Operations Specialist jobs
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 Specialist Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote claims operations specialist jobs.
- Two or more years of experience processing medical, P&C, or workers' compensation claims
- Proficiency in claims management systems such as Facets, TriZetto, or Guidewire
- Knowledge of ICD-10 coding, CPT codes, and EOB interpretation for medical claims roles
- Strong understanding of claims adjudication workflows, denial management, and appeals processes
- Associate or bachelor's degree in business, healthcare administration, or a related field
- Familiarity with state and federal claims regulations, compliance requirements, and audit procedures
Tips for Your Remote Claims Operations Specialist Job Search
Apply early to remote roles that fit
Migrate Mate lists remote claims operations specialist openings from across the U.S. in one place, so you can find roles that match your background and apply directly without sorting through unrelated postings.
Show your claims system proficiency upfront
Remote hiring managers for claims operations roles screen heavily for software fluency. Name the specific claims management platforms you have used, such as Guidewire or Duck Creek, in your resume summary and application materials so it's visible before the first interview.
Demonstrate async communication in your application
Remote claims operations work runs on written handoffs and documented decisions. Use your cover letter to show clear, precise written communication, since that signals you can coordinate claims workflows with teammates across time zones without needing real-time contact.
Prepare for remote workflow questions in interviews
Remote employers consistently ask how you track claim status, flag issues without escalating in person, and maintain accuracy under volume. Prepare specific examples of how you have managed claims queues, documented decisions, and kept processes moving independently.
Remote Claims Operations Specialist Jobs: Frequently Asked Questions
How do I get a remote claims operations specialist job?
Remote claims operations specialist roles go to candidates who can demonstrate self-direction, precise written communication, and the ability to manage claims workflows without in-person oversight. Insurance carriers and third-party administrators hiring remotely look for experience with claims management systems, attention to detail in documentation, and comfort working asynchronously across distributed teams. Highlighting results from previous claims work and showing you can operate independently will give you a clear edge.
Which companies hire remote claims operations specialists?
Employers currently hiring remote claims operations specialists include Allianz, CareSource, and My Claim Warrior, per current remote listings on Migrate Mate as of November 2026. Remote-first insurance carriers, health tech platforms, and distributed third-party administrators are the most consistent sources of remote openings for this role.
Can you get a remote claims operations specialist job with no experience?
Yes, but remote entry-level claims operations roles are harder to land because employers expect you to work independently from day one. Companies that hire entry-level remote candidates in this space often look for completed claims or insurance coursework, familiarity with claims software, and demonstrated organizational skills. Certifications from industry bodies and internship experience with any claims-adjacent work can open the door when direct experience is limited.
Do you need a degree for remote claims operations specialist jobs?
Not always. Many remote employers weigh hands-on claims experience, proficiency with claims management systems, and demonstrated accuracy in data-heavy work above a formal degree. An associate degree or relevant certifications in insurance or operations can substitute effectively. What remote hiring managers consistently prioritize is proof that you can handle claims workflows accurately and communicate clearly without in-person guidance.
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