Remote Healthcare Sales Specialist Jobs
Remote Healthcare Sales Specialist jobs are open across the U.S. in medical devices, pharmaceutical services, health technology, and managed care, at companies from regional distributors to remote-first health tech firms. Employers hiring remotely right now include Gallagher, CareerNation, and LMI. Find a role that fits below and apply directly.
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Position Summary
The Healthcare Claims Implementation Specialist serves as InfoMC’s primary domain authority for healthcare claims operations during new client onboarding engagements on the Incedo claims platform. This individual bridges the gap between client operational workflows and the technical capabilities of the Incedo solution, ensuring that each implementation is aligned with payer-side business requirements, regulatory obligations, and industry standards for electronic data interchange (EDI).
The BA/SME works directly with health plan and managed care organization clients to define requirements, configure workflows, validate transaction sets, and guide teams through end-to-end claims lifecycle processes—from member eligibility through remittance and adjudication. The ideal candidate brings deep payer-side experience with HIPAA-mandated EDI transactions, CMS reporting requirements, and the operational realities of claims processing within Medicare Advantage, Medicaid, and commercial health plan environments.
What the Healthcare Claims Implementation Specialist Does:
Claims Domain Expertise & Client Advisory
- Serve as the internal and client-facing subject matter expert on healthcare claims operations, EDI transaction standards, and payer-side adjudication logic throughout the Incedo onboarding lifecycle
- Translate client payer workflows and claims processing requirements into detailed business and functional specifications for the Incedo implementation team
- Advise clients on best practices for configuring claims intake, adjudication rules, coordination of benefits (COB), appeals and grievance workflows, and remittance processing within Incedo
- Identify gaps between client legacy processes and Incedo capabilities; document and escalate to product/engineering as applicable
- Support clients in designing claims data migration strategies, including crosswalks from legacy systems and validation of historical claims data integrity
EDI Transaction Set Knowledge & Validation
The BA/SME must possess hands-on functional knowledge of the following HIPAA-mandated ASC X12 transaction sets and their application in a payer environment:
- 834 – Benefit Enrollment and Maintenance: member eligibility file intake from CMS, employer groups, or TPAs; validation of enrollment spans, plan codes, and subscriber/dependent relationships
- 270 / 271 – Eligibility Inquiry and Response: real-time and batch eligibility verification, configuration of response logic and benefit information, and integration with member enrollment systems
- 837P / 837I – Professional and Institutional Claims: inbound claims intake, loop and segment validation, NPI/taxonomy routing, and coordination with Incedo adjudication engine
- 835 – Healthcare Claim Payment/Advice (ERA): remittance generation, CAS segment coding, ERA reconciliation against adjudicated claims, and ERA/EFT pairing
- 276 / 277 – Claim Status Request and Response: outbound claims status inquiry workflows, 277CA acknowledgment processing, and payer-to-provider communication configuration
- 278 – Health Care Services Review (Prior Authorization): inbound and outbound PA request/response workflows, integration with Incedo utilization management module, and CMS-0057-F electronic PA compliance
- 275 – Patient Information (Additional Information to Support a Health Care Claim): receipt and routing of clinical attachments and supporting documentation submitted by providers in conjunction with claims, including coordination with Incedo adjudication workflows requiring medical records or authorization documentation
- 999 / TA1 – Functional Acknowledgment and Interchange Acknowledgment: EDI gateway configuration, acknowledgment tracking, and error-handling workflows
Onboarding & Implementation Execution
- Lead business analysis workstreams during new client onboarding, including requirements discovery sessions, workflow mapping, and gap analysis documentation
- Develop and maintain detailed business requirements documents (BRDs), functional specifications, data mapping templates, and EDI companion guides customized to each client’s trading partner environment
- Coordinate with the client’s EDI team and clearinghouse partners to complete end-to-end transaction testing for all applicable X12 transaction sets
- Facilitate and support user acceptance testing (UAT) for claims processing scenarios, ensuring adjudication outcomes align with client benefit plan configuration and state/federal requirements
- Document client-specific configurations, workflow decisions, and known edge cases in InfoMC’s implementation knowledge base
- Partner with Engagement Managers and Technical Leads to ensure claims-related milestones are on track, risks are escalated promptly, and client expectations are managed
Regulatory & Compliance Alignment
- Maintain current knowledge of CMS regulations, HIPAA transaction and code set standards (45 CFR Part 162), and state Medicaid agency requirements as they affect claims operations
- Advise clients on compliance with CMS-0057-F (electronic prior authorization), No Surprises Act (NSA) claims adjudication timelines, and applicable state prompt pay laws
- Support clients in Medicare Advantage (Part C), Medicaid managed care, and CHIP programs in configuring Incedo to meet CMS encounter data submission requirements
- Monitor and communicate updates to X12 transaction standards, ICD/CPT/HCPCS code set releases, and CMS NCCI edits that may affect client configurations
Knowledge Sharing & Continuous Improvement
- Develop and maintain internal training materials, job aids, and onboarding playbooks related to claims operations and EDI workflows on the Incedo platform
- Mentor junior implementation staff on payer claims concepts, EDI troubleshooting, and client-facing discovery techniques
- Collaborate with InfoMC’s Product and Engineering teams to communicate client-driven enhancement requests and emerging market requirements
- Contribute to the ongoing refinement of InfoMC’s Implementation Playbook with claims-specific best practices and lessons learned
What the Healthcare Claims BA/SME Demonstrates:
- Deep command of the end-to-end claims lifecycle from the payer’s perspective: member eligibility, claims intake, adjudication, COB, appeals, and remittance
- Functional mastery of HIPAA ASC X12 transaction sets (834, 837P/I/D, 835, 270/271, 276/277, 278, 999/TA1) with the ability to read, interpret, and troubleshoot raw EDI files
- Ability to conduct structured discovery sessions with health plan operations teams, extract requirements, and translate them into actionable technical specifications
- Strong written communication skills, including the ability to produce clear BRDs, data dictionaries, and process flow diagrams
- Comfort operating in a client-facing role across multiple concurrent engagements, managing competing priorities with minimal supervision
- Collaborative mindset with the ability to coordinate across internal teams (Implementation, Product, Engineering, QA) and external stakeholders (client IT, clearinghouses, trading partners)
- Analytical rigor and attention to detail when validating EDI transaction data, reviewing adjudication outcomes, and auditing benefit plan configurations
- Working knowledge of relational databases and SQL sufficient to support data validation and claims reporting tasks
Qualifications
Required
- Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience
- Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity
- Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278
- Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding
- Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing
- Experience supporting software implementations or system migrations in a healthcare payer context
- Ability to travel to client sites as needed (estimated up to 20%)
- This role is not eligible for sponsorship
Preferred
- Experience with Medicare Advantage (Part C) or Medicaid managed care claims operations, including CMS encounter data submission
- Knowledge of CMS-0057-F electronic prior authorization requirements and their claims workflow implications
- Familiarity with No Surprises Act (NSA) independent dispute resolution and good faith estimate requirements
- Experience with utilization management or care management platforms that interface with claims adjudication
- CPHQ, RHIT, RHIA, or equivalent healthcare informatics certification
- Project Management Professional (PMP) certification
- SQL proficiency for claims data validation and ad hoc reporting
- Prior experience in a healthcare IT vendor or SaaS implementation environment
Physical Demands / Working Conditions
Light work: this position involves sitting, standing, and/or walking. This is a remote work environment requiring the ability to use a computer and communicate clearly by telephone and video conference. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Highlighted Benefits for InfoMC Team Members:
- InfoMC is an equal opportunity employer with a generous compensation plan
- Excellent earning potential with qualifying annual bonuses
- Health, Dental, and Vision Plan
- Life insurance, short- and long-term disability
- 401(k) retirement savings plan
- Paid holidays and vacation
- Work from home
- Flexible schedule
Pay: $90,000.00 - $115,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you have these qualifications? Explain your experience within.
- Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience
- Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity
- Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278
- Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding
- Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing
- Experience supporting software implementations or system migrations in a healthcare payer context
- What is your desired salary expectations?
Work Location: Remote
Position Summary
The Healthcare Claims Implementation Specialist serves as InfoMC’s primary domain authority for healthcare claims operations during new client onboarding engagements on the Incedo claims platform. This individual bridges the gap between client operational workflows and the technical capabilities of the Incedo solution, ensuring that each implementation is aligned with payer-side business requirements, regulatory obligations, and industry standards for electronic data interchange (EDI).
The BA/SME works directly with health plan and managed care organization clients to define requirements, configure workflows, validate transaction sets, and guide teams through end-to-end claims lifecycle processes—from member eligibility through remittance and adjudication. The ideal candidate brings deep payer-side experience with HIPAA-mandated EDI transactions, CMS reporting requirements, and the operational realities of claims processing within Medicare Advantage, Medicaid, and commercial health plan environments.
What the Healthcare Claims Implementation Specialist Does:
Claims Domain Expertise & Client Advisory
- Serve as the internal and client-facing subject matter expert on healthcare claims operations, EDI transaction standards, and payer-side adjudication logic throughout the Incedo onboarding lifecycle
- Translate client payer workflows and claims processing requirements into detailed business and functional specifications for the Incedo implementation team
- Advise clients on best practices for configuring claims intake, adjudication rules, coordination of benefits (COB), appeals and grievance workflows, and remittance processing within Incedo
- Identify gaps between client legacy processes and Incedo capabilities; document and escalate to product/engineering as applicable
- Support clients in designing claims data migration strategies, including crosswalks from legacy systems and validation of historical claims data integrity
EDI Transaction Set Knowledge & Validation
The BA/SME must possess hands-on functional knowledge of the following HIPAA-mandated ASC X12 transaction sets and their application in a payer environment:
- 834 – Benefit Enrollment and Maintenance: member eligibility file intake from CMS, employer groups, or TPAs; validation of enrollment spans, plan codes, and subscriber/dependent relationships
- 270 / 271 – Eligibility Inquiry and Response: real-time and batch eligibility verification, configuration of response logic and benefit information, and integration with member enrollment systems
- 837P / 837I – Professional and Institutional Claims: inbound claims intake, loop and segment validation, NPI/taxonomy routing, and coordination with Incedo adjudication engine
- 835 – Healthcare Claim Payment/Advice (ERA): remittance generation, CAS segment coding, ERA reconciliation against adjudicated claims, and ERA/EFT pairing
- 276 / 277 – Claim Status Request and Response: outbound claims status inquiry workflows, 277CA acknowledgment processing, and payer-to-provider communication configuration
- 278 – Health Care Services Review (Prior Authorization): inbound and outbound PA request/response workflows, integration with Incedo utilization management module, and CMS-0057-F electronic PA compliance
- 275 – Patient Information (Additional Information to Support a Health Care Claim): receipt and routing of clinical attachments and supporting documentation submitted by providers in conjunction with claims, including coordination with Incedo adjudication workflows requiring medical records or authorization documentation
- 999 / TA1 – Functional Acknowledgment and Interchange Acknowledgment: EDI gateway configuration, acknowledgment tracking, and error-handling workflows
Onboarding & Implementation Execution
- Lead business analysis workstreams during new client onboarding, including requirements discovery sessions, workflow mapping, and gap analysis documentation
- Develop and maintain detailed business requirements documents (BRDs), functional specifications, data mapping templates, and EDI companion guides customized to each client’s trading partner environment
- Coordinate with the client’s EDI team and clearinghouse partners to complete end-to-end transaction testing for all applicable X12 transaction sets
- Facilitate and support user acceptance testing (UAT) for claims processing scenarios, ensuring adjudication outcomes align with client benefit plan configuration and state/federal requirements
- Document client-specific configurations, workflow decisions, and known edge cases in InfoMC’s implementation knowledge base
- Partner with Engagement Managers and Technical Leads to ensure claims-related milestones are on track, risks are escalated promptly, and client expectations are managed
Regulatory & Compliance Alignment
- Maintain current knowledge of CMS regulations, HIPAA transaction and code set standards (45 CFR Part 162), and state Medicaid agency requirements as they affect claims operations
- Advise clients on compliance with CMS-0057-F (electronic prior authorization), No Surprises Act (NSA) claims adjudication timelines, and applicable state prompt pay laws
- Support clients in Medicare Advantage (Part C), Medicaid managed care, and CHIP programs in configuring Incedo to meet CMS encounter data submission requirements
- Monitor and communicate updates to X12 transaction standards, ICD/CPT/HCPCS code set releases, and CMS NCCI edits that may affect client configurations
Knowledge Sharing & Continuous Improvement
- Develop and maintain internal training materials, job aids, and onboarding playbooks related to claims operations and EDI workflows on the Incedo platform
- Mentor junior implementation staff on payer claims concepts, EDI troubleshooting, and client-facing discovery techniques
- Collaborate with InfoMC’s Product and Engineering teams to communicate client-driven enhancement requests and emerging market requirements
- Contribute to the ongoing refinement of InfoMC’s Implementation Playbook with claims-specific best practices and lessons learned
What the Healthcare Claims BA/SME Demonstrates:
- Deep command of the end-to-end claims lifecycle from the payer’s perspective: member eligibility, claims intake, adjudication, COB, appeals, and remittance
- Functional mastery of HIPAA ASC X12 transaction sets (834, 837P/I/D, 835, 270/271, 276/277, 278, 999/TA1) with the ability to read, interpret, and troubleshoot raw EDI files
- Ability to conduct structured discovery sessions with health plan operations teams, extract requirements, and translate them into actionable technical specifications
- Strong written communication skills, including the ability to produce clear BRDs, data dictionaries, and process flow diagrams
- Comfort operating in a client-facing role across multiple concurrent engagements, managing competing priorities with minimal supervision
- Collaborative mindset with the ability to coordinate across internal teams (Implementation, Product, Engineering, QA) and external stakeholders (client IT, clearinghouses, trading partners)
- Analytical rigor and attention to detail when validating EDI transaction data, reviewing adjudication outcomes, and auditing benefit plan configurations
- Working knowledge of relational databases and SQL sufficient to support data validation and claims reporting tasks
Qualifications
Required
- Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience
- Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity
- Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278
- Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding
- Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing
- Experience supporting software implementations or system migrations in a healthcare payer context
- Ability to travel to client sites as needed (estimated up to 20%)
- This role is not eligible for sponsorship
Preferred
- Experience with Medicare Advantage (Part C) or Medicaid managed care claims operations, including CMS encounter data submission
- Knowledge of CMS-0057-F electronic prior authorization requirements and their claims workflow implications
- Familiarity with No Surprises Act (NSA) independent dispute resolution and good faith estimate requirements
- Experience with utilization management or care management platforms that interface with claims adjudication
- CPHQ, RHIT, RHIA, or equivalent healthcare informatics certification
- Project Management Professional (PMP) certification
- SQL proficiency for claims data validation and ad hoc reporting
- Prior experience in a healthcare IT vendor or SaaS implementation environment
Physical Demands / Working Conditions
Light work: this position involves sitting, standing, and/or walking. This is a remote work environment requiring the ability to use a computer and communicate clearly by telephone and video conference. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this role.
Highlighted Benefits for InfoMC Team Members:
- InfoMC is an equal opportunity employer with a generous compensation plan
- Excellent earning potential with qualifying annual bonuses
- Health, Dental, and Vision Plan
- Life insurance, short- and long-term disability
- 401(k) retirement savings plan
- Paid holidays and vacation
- Work from home
- Flexible schedule
Pay: $90,000.00 - $115,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Flexible schedule
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Application Question(s):
- Do you have these qualifications? Explain your experience within.
- Bachelor’s Degree in Health Information Management, Healthcare Administration, Computer Science, Business, or equivalent work experience
- Minimum of 5 years of experience in a healthcare payer environment (health plan, managed care organization, TPA, or Medicare Advantage plan) in a claims operations or claims business analyst capacity
- Demonstrated hands-on experience with HIPAA X12 EDI transactions including 834, 837P/I/D, 835, 270/271, 275, 276/277, and 278
- Experience with claims adjudication systems, clearinghouse relationships, and payer-side EDI trading partner onboarding
- Familiarity with ICD-10, CPT, HCPCS Level II, revenue codes, and NCCI edits in the context of claims processing
- Experience supporting software implementations or system migrations in a healthcare payer context
- What is your desired salary expectations?
Work Location: Remote
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Find JobsRemote Healthcare Sales Specialist Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote healthcare sales specialist jobs.
- Bachelor's degree in business, life sciences, or a related field
- Proven outside sales experience, preferably in medical devices or pharmaceuticals
- Ability to build and manage relationships with clinical and administrative stakeholders
- Familiarity with CRM platforms such as Salesforce for pipeline and activity tracking
- Valid driver's license and willingness to travel within an assigned territory
- Experience selling in hospital, clinic, or integrated delivery network environments
Tips for Your Remote Healthcare Sales Specialist Job Search
Apply early to remote roles that fit
Migrate Mate lists remote healthcare sales 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 mixed listings.
Highlight async communication skills upfront
Remote healthcare sales employers prioritize written communication because updates to managers, handoffs between team members, and client follow-ups all happen asynchronously. Lead your resume summary and cover letter with concrete examples of written outreach that moved deals forward.
Show CRM discipline with specific examples
Remote sales managers judge pipeline health through CRM data, not hallway check-ins. Name the platforms you've used, Salesforce, HubSpot, or similar, and describe how consistently you logged activity, updated stages, and used reporting to manage your territory without prompting.
Prepare your remote interview setup deliberately
Healthcare sales remote interviews often involve live product walkthroughs or role-play scenarios over video. Set up a clean, well-lit background, test your audio, and practice delivering a concise virtual product pitch before your interview so technical issues don't distract from your performance.
Remote Healthcare Sales Specialist Jobs: Frequently Asked Questions
How do I get a remote healthcare sales specialist job?
Target companies that operate distributed sales teams, including health technology platforms, telehealth providers, and specialty pharmaceutical firms with national territory coverage. Remote healthcare sales employers screen heavily for self-direction, clear written communication, and CRM discipline, since pipeline visibility matters more when managers can't walk the floor. Demonstrating a history of hitting quota without daily supervision gives candidates a clear edge over those with comparable experience who've only worked in office environments.
Which companies hire remote healthcare sales specialists?
Remote healthcare sales specialist roles are posted by Gallagher, CareerNation, and LMI and others right now, based on current remote listings on Migrate Mate as of September 2026. These include remote-first health technology companies, distributed specialty pharma teams, and medical device firms managing national account territories across multiple regions.
Can you get a remote healthcare sales specialist job with no experience?
Yes, but entry-level remote healthcare sales roles are harder to land because employers expect you to ramp independently without in-person coaching. Health technology startups and inside sales teams at telehealth companies are the most likely to hire entry-level remotely. Showing completion of a healthcare or sales certification, documented outreach results from internships, or familiarity with CRM tools like Salesforce or HubSpot can substitute meaningfully for direct experience.
Do you need a degree for remote healthcare sales specialist jobs?
Not always. Remote employers in health technology and specialty pharma weigh verifiable sales results, clinical product knowledge, and CRM proficiency alongside formal credentials. A degree in life sciences or business strengthens applications for clinical or enterprise accounts, but demonstrated performance, relevant certifications, and a portfolio of closed deals carry real weight in hiring decisions for distributed teams.
See All 18 Remote Healthcare Sales Specialist Jobs
Find roles that match your experience and apply in just a few clicks.
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