Remote Health Claims Specialist: Precise Adjudication

Naukri Mitra; United States; Remote; USD 58,000 - 71,000; Full time

Job summary

Naukri Mitra is seeking a Remote Health Insurance Claims Examiner to evaluate and adjudicate claims with HIPAA compliance, accuracy, and compassion. The role supports members nationwide while working from home.

You will review claims using ICD-10, CPT, and HCPCS codes, determine payments, communicate findings to providers and members, and maintain precise documentation in audit systems. This remote position emphasizes quality, speed, and collaboration.

Qualifications

• 2+ years of experience as a health insurance claims examiner or related role.
• Strong understanding of insurance guidelines, benefit plans, and claims adjudication processes.
• Proficiency in interpreting medical codes (ICD-10, CPT, HCPCS).
• Excellent written and verbal communication skills.
• Exceptional precision in handling data and organizing tasks.

Responsibilities

• Review and adjudicate claims for accuracy, eligibility, and payment decisions.
• Determine claim payment or denial based on medical necessity and policy coverage.
• Use ICD-10, CPT, and HCPCS codes for claim assessment.
• Communicate findings with providers and members; obtain needed documentation.
• Maintain records and document decisions in audit/quality systems.

Skills

2+ years experience

Insurance guidelines

Medical codes interpretation

Written and verbal communication

Data precision

Self-management

Education

Medical coding certification (AHIMA/AAPC)

Tools

Facets/QNXT

ICD-10

CPT/HCPCS

Microsoft Office

EHR systems

Job description

Naukri Mitra is seeking a Remote Health Insurance Claims Examiner to evaluate and adjudicate claims with HIPAA compliance, accuracy, and compassion. The role supports members nationwide while working from home.

You will review claims using ICD-10, CPT, and HCPCS codes, determine payments, communicate findings to providers and members, and maintain precise documentation in audit systems. This remote position emphasizes quality, speed, and collaboration.