Remote Medical Claims Examiner Jobs
Remote Medical Claims Examiner jobs are open across the U.S. in health insurance, managed care, and third-party administration, where distributed teams review and adjudicate medical claims without a physical office. Employers hiring remotely 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 17+ Remote Medical Claims 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.
See All 17 Remote Medical Claims Examiner Jobs
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Find JobsRemote Medical Claims Examiner Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote medical claims examiner jobs.
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Experience processing medical, dental, or pharmacy claims end to end
- Familiarity with claims adjudication platforms such as TriZetto or Facets
- Understanding of explanation of benefits documents and coordination of benefits rules
- High school diploma or associate degree, with a bachelor preferred at senior levels
- Professional certification such as CPC, CCS, or CHC from an accredited body
Tips for Your Remote Medical Claims Examiner Job Search
Apply early to remote roles that fit
Migrate Mate lists remote medical claims examiner openings from across the U.S. in one place, so you can find roles that match your experience and apply directly. Remote postings at established insurers and administrators fill fast, so checking regularly and applying promptly puts you ahead.
Prove your accuracy in writing upfront
Remote medical claims examiners are judged almost entirely on written output. In your cover letter and any skills assessments, lead with specific metrics: claims volume processed, error rates, or adjudication turnaround. Numbers you can defend make a stronger case than general claims of thoroughness.
Highlight your claims software experience
Remote employers can't watch you work, so they screen hard for platform fluency. Name the claims management and adjudication systems you've used, such as Facets, TriZetto, or ClaimLogiq, in your resume's skills section. Specific software familiarity removes a major hiring hesitation for distributed teams.
Prepare for async interview formats
Many remote-first insurers and third-party administrators use video or written screening assessments before a live interview. Practice answering claims-specific scenario questions in writing and on camera, focusing on how you identify discrepancies, apply payer policies, and escalate edge cases without immediate supervisor access.
Remote Medical Claims Examiner Jobs: Frequently Asked Questions
How do I get a remote medical claims examiner job?
Remote medical claims examiner roles go to candidates who can demonstrate self-directed accuracy without in-person oversight. Insurers and third-party administrators hiring remotely screen hard for experience with claims management platforms, ICD and CPT coding familiarity, and clear written communication. Candidates who can show low error rates, fast adjudication turnaround in prior roles, and comfort working asynchronously in distributed teams consistently edge out those who can only point to general claims experience.
Which companies hire remote medical claims examiners?
Companies hiring remote medical claims examiners right now include Sedgwick, TRISTAR, and WPS Health Solutions, based on current remote listings on Migrate Mate as of November 2026. Health insurers, managed care organizations, and third-party administrators make up the bulk of remote hiring, since their claims operations run entirely on digital systems that don't require examiners to be on site.
Can you get a remote medical claims examiner job with no experience?
Yes, but remote entry-level roles are harder to land because employers expect you to work independently from day one with minimal hand-holding. Some third-party administrators and smaller managed care firms hire entry-level remote examiners and train them on their systems. Completing a medical billing and coding certification, demonstrating familiarity with ICD-10 and CPT codes, and showing strong attention to detail in a skills assessment can open the door when direct experience is thin.
Do you need a degree for remote medical claims examiner jobs?
Not always. Many remote employers care more about claims processing skills, coding knowledge, and demonstrated accuracy than a specific degree. A high school diploma combined with a medical billing or coding certification from AAPC or AHIMA is a common and accepted path. Employers weigh prior claims volume, software proficiency, and low error rates heavily, especially for fully remote roles where on-the-job supervision is limited.
See All 17 Remote Medical Claims Examiner Jobs
Find roles that match your experience and apply in just a few clicks.
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