Remote Health Claims Specialist Jobs in Canada

Introduction to the Role

Are you highly detail-oriented and passionate about supporting patients behind the scenes? As a Remote Health Claims Specialist, you'll play an essential role in Canada's healthcare system by verifying, processing, and resolving health insurance claims. Working from the comfort of your home, you’ll collaborate with healthcare providers, insurance firms, and patients to ensure timely and accurate claims administration. This role is well-suited for professionals who excel in precision, understand medical terminology, and enjoy working with sensitive data in a confidential and secure environment.

Position Overview

Key Details

• Job Title: Remote Health Claims Specialist
• Location: Remote – Canada
• Employment Type: Full-time
• Annual Salary: $62,940
• Work Schedule: Monday to Friday, Flexible Day Hours

Key Responsibilities

Core Duties

• Review and process health insurance claims submitted by patients or healthcare providers.
• Confirm claim accuracy, validate supporting documents, and match codes with diagnosis and procedures.
• Ensure claims comply with insurance policies, provincial standards, and legal regulations.
• Identify incomplete or inconsistent submissions and follow up for corrections or clarifications.
• Coordinate with cross-functional teams and partners to address discrepancies in claims.
• Input verified data into secure systems using specialized software tools
• Generate status reports and maintain detailed records for audits and compliance reviews
• Respond to policyholder inquiries regarding claim statuses, denials, or reimbursement issues
• Collaborate with the fraud prevention team to flag suspicious claims or billing inconsistencies

Work Environment

Remote Office Setup

• Fully remote setup with structured onboarding and virtual training support
• Requires a distraction-free, secure home workspace with a stable internet connection
• Collaborative virtual communication with the backing of supervisors and fellow claims specialists
• Access to digital workflow tools for document sharing, team updates, and task tracking

Tools and Technologies

Digital Platforms and Software

• Health claims management systems (e.g., Telus Health, MedAccess)
• Secure CRM platforms and cloud-based case tracking tools
• Encrypted email and video conferencing tools for patient or provider communication
• Document scanning and digital signature solutions
• Compliance dashboards and audit monitoring software

Qualifications and Experience

Required Qualifications

• Diploma or degree in healthcare administration, insurance, medical billing, or related field
• At least two years of hands-on experience in managing health claims or healthcare billing processes
• Strong knowledge of medical coding standards (ICD-10, CPT, OHIP codes)
• Excellent organizational and analytical skills
• Ability to read and interpret policy documents and clinical records
• Comfortable handling confidential data with professionalism and discretion
• Proficient in Microsoft Excel, digital forms, and cloud-based documentation systems
• Strong written and verbal communication abilities
• Adaptable and self-motivated with excellent time management skills

Desirable Attributes

• Bilingual (English/French) communication skills are a plus
• Certification in Health Insurance Claims Management or Medical Billing is advantageous
• Previous experience working with Canadian healthcare systems or insurance providers
• Exposure to remote work environments with independent task handling

Compensation and Benefits

What You’ll Receive

• Competitive annual salary of $62,940
• Comprehensive health and dental coverage
• Retirement savings plan with employer contributions
• Paid vacation days, wellness leave, and flexible holiday options
• Learning stipend for courses and certifications
• Access to mental health support programs and virtual fitness memberships
• Work-life balance support through flexible scheduling

Growth and Career Development

Professional Opportunities

• Opportunity to move into supervisory roles such as Claims Team Lead or Compliance Auditor
• Cross-training is available for related remote roles in insurance coordination, billing verification, and policy underwriting.
• Ongoing development through internal webinars, certifications, and mentorship programs

Impact and Collaboration

Why This Role Matters

Your attention to detail ensures patients receive timely care reimbursements and accurate claim handling. By identifying inconsistencies, reducing fraud risk, and upholding compliance, your role supports the integrity of Canada’s healthcare reimbursement ecosystem. Every accurate claim processed is a step toward a healthier, more accessible system for everyone.

Who You'll Work With

You’ll interact with case managers, benefit coordinators, healthcare providers, and insurance specialists across the country. Your role sits at the intersection of healthcare administration and remote customer service, giving you the chance to impact outcomes without being on the clinical frontlines.

What Success Looks Like

• High accuracy rates in data entry and claim evaluations
• Timely follow-ups and resolution of pending or denied claims
• Positive feedback from colleagues and healthcare partners
• Active participation in team meetings and process improvement initiatives

Call to Action

If you're ready to bring accuracy, care, and compliance to the forefront of Canada’s healthcare claims processing system, this is your moment. Join a mission-driven team where your work from home will have a direct, meaningful impact. Apply now to become a Remote Health Claims Specialist and help shape a more efficient, transparent, and compassionate healthcare landscape.