Remote Compliance Examiner Jobs
Remote compliance examiner jobs are in active demand across the U.S., with remote-first firms and distributed teams regularly hiring for roles in financial services, healthcare, and regulatory technology. Employers hiring remote compliance examiners right now include Sedgwick, TRISTAR, and WPS Health Solutions. See the openings below and apply to the ones that match your experience.
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Showing 5 of 20+ Remote Compliance Examiner jobs
POSITION SUMMARY
The Claims Examiner is responsible for determining the proper payment (if any) of medical claims by group health plans, based upon specific knowledge and application of each client’s customized plan(s).
ESSENTIAL FUNCTIONS
- Independently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud.
- Determine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider.
- Contact providers to negotiate discounts.
- Log claims negotiated in Access database and create weekly summary reports.
- Review and understand the terms and conditions of each clients’ customized plans.
- Understand and comply with all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Request, review and analyze any physician notes, hospital records or police reports.
- Consult with other entities who can offer additional evaluation of a claim.
- Process claims in the QicLink System.
- Review, analyze and add applicable notes to the QicLink System.
- Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.
- Review billed procedure and diagnosis codes on claims for billing irregularities.
- Analyze claims for billing inconsistencies.
- Review and analyze specific procedure and diagnosis codes for medical necessity.
- Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
- Review Suspended Claim Reports and follow up on open issues.
- Assist and support other team members as needed and when requested.
- Attend continuing education classes as required, including but not limited to HIPAA training.
- Other duties as assigned.
EDUCATION
- High School Diploma, College and Advanced Degrees Preferred or equivalent work experience required.
EXPERIENCE AND SKILLS
- Must have a minimum of 5 years of medical claims analysis experience (including dental and vision claims analysis).
- Strong analytical skills
- Knowledge of computer systems and CPT and ICD-9 coding terminology.
- Continuing education in all areas affecting group health and welfare plans is required.
POSITION COMPETENCIES
- Accountability
- Analytical Thinking
- Collaboration
- Communication
- Customer Focus
- Functional Expertise
- Initiative
PHYSICAL DEMANDS
- This is standard desk role requiring extended periods of sitting and computer work.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
POSITION SUMMARY
The Claims Examiner is responsible for determining the proper payment (if any) of medical claims by group health plans, based upon specific knowledge and application of each client’s customized plan(s).
ESSENTIAL FUNCTIONS
- Independently review and analyze health care claims for: 1) reasonableness of cost; 2) medically unnecessary treatment by physicians and hospitals; and 3) fraud.
- Determine whether a health plan provides benefits in connection with the claim submitted and the level of benefits to be paid to the provider.
- Contact providers to negotiate discounts.
- Log claims negotiated in Access database and create weekly summary reports.
- Review and understand the terms and conditions of each clients’ customized plans.
- Understand and comply with all applicable privacy and security laws, including but not limited to HIPAA, HITECH and any regulations promulgated thereto.
- Request, review and analyze any physician notes, hospital records or police reports.
- Consult with other entities who can offer additional evaluation of a claim.
- Process claims in the QicLink System.
- Review, analyze and add applicable notes to the QicLink System.
- Document all information gathered in available systems as needed, including the QicLink System and alliedbenefit.com.
- Review billed procedure and diagnosis codes on claims for billing irregularities.
- Analyze claims for billing inconsistencies.
- Review and analyze specific procedure and diagnosis codes for medical necessity.
- Authorize payment, partial payment or denial of claim based upon individual investigation and analysis.
- Review Suspended Claim Reports and follow up on open issues.
- Assist and support other team members as needed and when requested.
- Attend continuing education classes as required, including but not limited to HIPAA training.
- Other duties as assigned.
EDUCATION
- High School Diploma, College and Advanced Degrees Preferred or equivalent work experience required.
EXPERIENCE AND SKILLS
- Must have a minimum of 5 years of medical claims analysis experience (including dental and vision claims analysis).
- Strong analytical skills
- Knowledge of computer systems and CPT and ICD-9 coding terminology.
- Continuing education in all areas affecting group health and welfare plans is required.
POSITION COMPETENCIES
- Accountability
- Analytical Thinking
- Collaboration
- Communication
- Customer Focus
- Functional Expertise
- Initiative
PHYSICAL DEMANDS
- This is standard desk role requiring extended periods of sitting and computer work.
WORK ENVIRONMENT
- Remote
Here at Allied, we believe that great talent can thrive from anywhere. Our remote friendly culture offers flexibility and the comfort of working from home, while also ensuring you are set up for success. To support a smooth and efficient remote work experience, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 100Mbps download/25Mbps upload. Reliable internet service is essential for staying connected and productive.
The company has reviewed this job description to ensure that essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills, and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
Compensation is not limited to base salary. Allied values our Total Rewards, and offers a competitive Benefit Package including, but not limited to, Medical, Dental, Vision, Life and Disability Insurance, Generous Paid Time Off, Tuition Reimbursement, EAP, and a Technology Stipend.
Allied reserves the right to amend, change, alter, and revise, pay ranges and benefits offerings at any time. All applicants acknowledge that by applying to the position you understand that the specific pay range is contingent upon meeting the qualification and requirements of the role, and for the successful completion of the interview selection and process. It is at the Company's discretion to determine what pay is provided to a candidate within the range associated with the role.
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Find JobsRemote Compliance Examiner Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote compliance examiner jobs.
- Bachelor's degree in finance, accounting, business, or a related field
- Knowledge of federal and state regulatory frameworks such as BSA, Dodd-Frank, or HIPAA
- Experience conducting compliance examinations, audits, or internal reviews
- Proficiency in writing clear examination reports and regulatory findings
- Familiarity with risk-based examination methodologies and sampling techniques
- Professional certification such as CRCM, CFE, CAMS, or CIA preferred
Tips for Your Remote Compliance Examiner Job Search
Signal remote readiness in your resume
Highlight experience with async documentation workflows, remote audit tools, and self-managed regulatory review cycles. Compliance examiners who explicitly name the systems and practices they use to work independently stand out to remote hiring teams screening for minimal oversight requirements.
Apply early to remote roles that fit
Migrate Mate lists remote compliance examiner 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 listings.
Demonstrate written communication for remote compliance
Remote compliance examiners communicate findings, flag issues, and coordinate with legal and operations teams almost entirely in writing. Your cover letter and any writing samples are live demonstrations of that ability, so make them precise, structured, and free of ambiguity.
Prepare for remote compliance interview scenarios
Remote interviewers for compliance roles consistently probe how you handle ambiguous regulatory questions without immediate access to a supervisor. Prepare concrete examples of times you resolved a compliance issue independently, documented your reasoning, and escalated appropriately.
Remote Compliance Examiner Jobs: Frequently Asked Questions
How do I get a remote compliance examiner job?
Target companies with distributed teams and remote-first cultures, particularly in financial services, insurtech, and healthcare, where compliance functions are well-suited to remote delivery. Remote employers screen heavily for self-direction, precise written communication, and the ability to manage documentation workflows without in-person oversight. Certifications like CRCM, CCEP, or CFE strengthen your profile, and demonstrating experience with regulatory reporting tools and async collaboration signals you can operate independently from day one.
Which companies hire remote compliance examiners?
Companies hiring remote compliance examiners right now include Sedgwick, TRISTAR, and WPS Health Solutions, based on current remote listings on Migrate Mate as of November 2026. Remote openings for this role concentrate at remote-first financial institutions, distributed insurtech firms, and healthcare organizations that manage compliance across multiple states.
Can you get a remote compliance examiner job with no experience?
Yes, but remote entry-level compliance examiner roles are harder to land because employers expect you to work independently without on-site supervision from day one. Your best path is targeting remote-first fintech or healthcare companies that run structured onboarding programs. Showing completed compliance coursework, a relevant certification like CRCM or CCEP, and demonstrated ability to manage detail-heavy work independently can open doors when direct experience is thin.
Do you need a degree for remote compliance examiner jobs?
Not always. Many remote employers weigh demonstrated compliance knowledge, industry certifications, and a record of managing regulatory processes as heavily as a formal degree. Fields like financial services often specify a bachelor's in business, finance, or a related area, but candidates with strong practical skills in audit documentation, risk assessment, and regulatory reporting regularly qualify for remote roles without a four-year degree.
See All 20 Remote Compliance Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
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