Remote Medical Claims Specialist Jobs
Remote medical claims specialist jobs are actively hiring across the U.S. at remote-first insurers, distributed healthcare administrative teams, and third-party billing organizations. Employers hiring remotely right now include CorVel Corporation, Parallon, and Sedgwick. Scan the live roles below and apply to whichever ones fit.
Find JobsOverview
Showing 5 of 18+ Remote Medical Claims Specialist jobs
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Sr. Claims Specialist, Medical Malpractice | Remote- Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
- Negotiates claim settlement up to designated authority level.
- Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
- Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlements
- Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
- Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Represents Company in depositions, mediations, and trial monitoring as needed.
- Communicates claim activity and processing with the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- Delegates work and mentors assigned staff.
QUALIFICATIONS
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
Six (6) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products<
- Analytical and interpretive skills
- Strong organizational skills
- Excellent negotiation skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $110,000-$120,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Sr. Claims Specialist, Medical Malpractice | Remote- Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions.
- Negotiates claim settlement up to designated authority level.
- Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life.
- Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlements
- Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines.
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients.
- Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost.
- Represents Company in depositions, mediations, and trial monitoring as needed.
- Communicates claim activity and processing with the client; maintains professional client relationships.
- Ensures claim files are properly documented and claims coding is correct.
- Refers cases as appropriate to supervisor and management.
- Delegates work and mentors assigned staff.
QUALIFICATIONS
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certification as applicable to line of business preferred.
Six (6) years of claims management experience or equivalent combination of education and experience required.
Skills & Knowledge
- Performs other duties as assigned.
- Supports the organization's quality program(s).
- In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products<
- Analytical and interpretive skills
- Strong organizational skills
- Excellent negotiation skills
- Good interpersonal skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
When applicable and appropriate, consideration will be given to reasonable accommodations.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $110,000-$120,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
See All 18 Remote Medical Claims Specialist Jobs
Find roles that match your experience and apply in just a few clicks.
Find JobsRemote Medical Claims Specialist Job Market
Who's Hiring
What Employers Look For
The qualifications that appear most often in remote medical claims specialist jobs.
- One to three years of medical claims processing or billing experience
- Proficiency with practice management or claims adjudication software such as Epic or Waystar
- Knowledge of ICD-10, CPT, and HCPCS coding systems
- Familiarity with Medicare, Medicaid, and commercial payer billing guidelines
- Experience working denied or rejected claims through resolution
- High school diploma or equivalent required, with an associate degree or coding certification preferred
Tips for Your Remote Medical Claims Specialist Job Search
Apply early to remote roles that fit
Migrate Mate lists remote medical claims specialist openings from across the U.S. in one place. Search roles by the criteria that matter to you and apply directly to the ones that match your background before competition builds.
Show your claims software proficiency upfront
Remote employers can't observe your workflow in person, so name the specific platforms you've used, such as Availity, Waystar, or Change Healthcare, in your resume and cover letter. Concrete software experience signals you won't need hand-holding from a distance.
Document your accuracy and resolution rates
Remote hiring managers for claims roles look for measurable outcomes. Quantify your denial overturn rate, clean claims percentage, or average processing volume. Numbers tied to accuracy and efficiency do the work that an in-person reference would otherwise do.
Prepare for async-first remote interviews
Many remote claims teams use written assessments or asynchronous video screens before live interviews. Practice explaining your claims review process clearly in writing and be ready to walk through a denial scenario step by step without back-and-forth.
Remote Medical Claims Specialist Jobs: Frequently Asked Questions
How do I get a remote medical claims specialist job?
Remote medical claims specialist roles go to candidates who can demonstrate self-direction and precise written communication from day one. Insurers and billing companies hiring remotely screen for proficiency in claims management software, knowledge of coding systems like ICD-10 and CPT, and a clear history of resolving claims independently. Candidates who document measurable outcomes, such as denial reduction or processing accuracy rates, stand out in remote hiring.
Which companies hire remote medical claims specialists?
Companies hiring remote medical claims specialists right now include CorVel Corporation, Parallon, and Sedgwick, based on current remote listings on Migrate Mate as of November 2026. Remote openings for this role concentrate at remote-first health insurers, distributed revenue cycle management firms, and third-party administrators operating across multiple states.
Can you get a remote medical claims specialist job with no experience?
Yes, but remote entry-level roles are harder to land because employers expect you to work independently without on-site supervision from the start. Entry paths include completing a medical billing and coding certificate, building familiarity with claims software, and targeting smaller remote-first billing companies or clearinghouses that train in-role. Demonstrating comfort with async communication and digital documentation tools opens more doors than experience alone.
Do you need a degree for remote medical claims specialist jobs?
Not always. Remote employers in this field prioritize demonstrated coding knowledge, claims processing accuracy, and familiarity with payer guidelines over a four-year degree. A medical billing and coding certificate, hands-on experience with denial management, and proficiency with claims platforms carry significant weight. Some employers do prefer an associate degree in health information management, but many hire based on verified skills and results.
See All 18 Remote Medical Claims Specialist Jobs
Find roles that match your experience and apply in just a few clicks.
Find Jobs