Remote Healthcare Claims Specialist — $65,562 per Year
A claim moves through many hands before it becomes a payment. Yours will be one of the last stops that actually matters. As a Remote Healthcare Claims Specialist, you'll check codes, chase down inconsistencies, and push claims through to resolution so providers get paid correctly and on time. Some days that means clean, fast processing. Other days it means digging into a messy file until the numbers add up.
The Short Version
You're reviewing claims, catching errors before they turn into denials, and working directly with providers and payers when something doesn't line up. It's detail-heavy work. People who do it well tend to notice patterns others miss, and they don't mind repetition as long as it's meaningful.
What the Job Actually Involves
- Process electronic and paper-based health insurance claims through claims adjudication platforms
- Check CPT, ICD-10, and HCPCS codes against payer policies
- Track down and fix discrepancies in submitted documentation
- Talk directly with providers and payers to sort out disputes
- Keep patient and claims data accurate in the claims management system you're assigned to
- Follow HIPAA and payer-specific record-keeping rules without exception
- Watch processing times, approval rates, and denial trends, and say something when a pattern looks off
None of this is glamorous work, but it's the kind that either holds a healthcare system together or lets it fall apart in small, expensive ways.
What You'll Need
Education: Associate degree, minimum.
Experience: At least 2 years processing healthcare claims. Remote experience is a plus, though not required if your background is otherwise solid.
Beyond that, you should be comfortable with CPT, ICD-10, and HCPCS coding, know your way around Medicare, Medicaid, and private payer requirements, and be able to work inside a cloud-based claims system without hand-holding. Communication matters too — you'll be writing to providers and sometimes explaining a denial in plain terms, so clarity counts as much as accuracy.
Not Required, But It Helps
- Bachelor's degree in Health Information Management, Medical Billing, or something adjacent
- CPC or CCS-P coding certification
- Hands-on time with Epic, eClinicalWorks, or Availity
- A history of lowering denial rates or improving first-pass approvals
- Some exposure to automation tools used for repetitive claims tasks
Pay and Perks
The role pays $65,562 a year. Beyond salary, you'll get real flexibility in your schedule — this is output-based work, not clock-watching — along with health coverage, paid time off you're actually expected to take, and reimbursement for certifications and coding courses. There's also a clear track from this role into positions like Revenue Cycle Analyst or Compliance Auditing Specialist, if that's where you want to head.
Day-to-Day Team Setup
Roles like this one are posted through Naukri Mitra fairly often, usually by teams that run lean yet structured. Expect short virtual standups, metrics-based check-ins instead of vague performance reviews, and most conversation happening over Slack or Teams. If a claim gets complicated, there's someone to loop in — this isn't a job where you're left to figure everything out alone.
Tools You'll Be Using
Claims software includes ClaimX, Medisoft, and eClinicalWorks. For clearinghouse work, expect Availity or Office Ally. Repetitive tasks get offloaded to RPA tools where possible, and everything runs through two-factor authentication and encrypted, HIPAA-compliant storage. When you need to make sense of trends across a large volume of claims, Tableau and Power BI do the heavy lifting.
Where This Is Open To
Candidates from the US, Canada, the UK, the EU, Australia, India, and a number of other regions are welcome to apply, as long as you have reliable internet and a workspace where you can concentrate.
Applying
Send a resume, and add a short note on which claims systems and payer types you've handled most. Mention any coding certifications you hold. If you've ever fixed a broken claims workflow or trained someone else on a new system, say so — that kind of detail tells us more than a list of software names. Shortlisted applicants move to a short conversation, followed by a practical exercise based on actual claims scenarios.
