Remote Health Insurance Claims Adjuster

Naukri Mitra; United States; Remote; USD 57,000 - 70,000; Full time

Job summary

Naukri Mitra is seeking a Remote Health Insurance Claims Adjuster to review, audit, and resolve health insurance claims from home.

You will work with providers, policyholders, and internal teams, use cloud-based claims software and EHR access, ensure HIPAA compliance, and earn $63,500 per year with full remote benefits.

Qualifications

• High school diploma or equivalent.
• 2+ years handling health claims, medical billing, or comparable insurance work.
• Knowledge of ICD-10, CPT, HCPCS coding systems and medical terminology.
• Understanding of claim adjudication and reimbursement processes.
• Familiarity with HIPAA and healthcare compliance.

Responsibilities

• Review submitted claims for completeness, policy coverage, and adherence to plan guidelines.
• Audit billing, coding, and provider documentation for accuracy before claims move forward.
• Communicate with healthcare providers, policyholders, and internal departments to resolve discrepancies.
• Maintain detailed records in the claims management system for audit readiness.
• Check claims against federal/state regulations and flag potential fraud or abuse.
• Attend training sessions and apply feedback to improve performance.

Job description

Somebody has to be the person who actually reads the claim before deciding what happens next — not the automated flag, not the algorithm, an actual person checking whether the coding lines up, whether the coverage applies, whether the provider documentation holds together. That's this job, and it's more consequential than most people assume when they see "claims adjuster" on a job board. We're hiring a Remote Health Insurance Claims Adjuster to review, audit, and resolve health insurance claims from home. It's detail work with real stakes attached — get it right and a policyholder gets paid what they're owed on time; miss something, and it snowballs into disputes, delays, or worse. Salary: $63,500 per year, fully remote.

What You'll Actually Be Doing

• Review submitted claims for completeness, policy coverage, and adherence to plan guidelines
• Audit billing, coding, and provider documentation for accuracy before claims move forward
• Talk directly with healthcare providers, policyholders, and internal departments to sort out discrepancies
• Keep detailed, accurate records in the claims management system — the kind that hold up if someone audits your work later
• Check claims against federal and state regulations, and flag anything that looks like fraud or abuse
• Show up to training sessions and quality reviews, and actually use the feedback

Minimum Qualifications

• Minimum education required: High school diploma or equivalent
• At least 2 years spent handling health claims, medical billing, or comparable insurance work
• Working knowledge of ICD-10, CPT, and HCPCS coding systems, plus general medical terminology
• Understanding of how claim adjudication and reimbursement actually work in practice, not just in theory
• Familiarity with HIPAA rules and general healthcare compliance requirements

Where a Little Extra Helps

• A certification through AHIMA, AAPC, or a similar body — not required, but it does get noticed
• Some post-secondary coursework or a degree in a healthcare-related field
• Comfort with video calls, shared drives, and ticketing systems used for day-to-day remote collaboration
• Communication skills sharp enough to explain a denial or a coding issue to someone who's frustrated, without making it worse

Working Remotely, Not Working Alone

You'll set your own pace within the structure of the role, but this isn't a job where you disappear into a queue and never hear from anyone. Expect regular check-ins with your manager, a peer group you can actually ask questions to, and support that's responsive rather than theoretical.

Job seekers comparing remote healthcare postings on platforms like Naukri Mitra tend to notice how many of them skip the actual tools involved — here's what you'd be working with day to day:

• Cloud-based claims processing software
• Electronic health record (EHR) system access
• HIPAA-compliant messaging and video tools
• Digital audit and workflow tracking software
• A secured remote desktop environment with standard cybersecurity protocols

Growth From Here

People don't usually stay in an entry-tier adjuster role forever. Depending on performance and interest, paths open up toward senior claims positions, quality assurance work, or team leadership. There's also ongoing access to webinars, certification support, and exposure to newer areas like telemedicine claims processing — useful if you want to specialize rather than stay generalist.

Why the Role Matters More Than It Sounds Like It Would

A claim sitting in review isn't abstract to the person waiting on it. It might be a parent trying to figure out whether a hospital stay gets covered, or a provider waiting on reimbursement to keep their practice running. The accuracy and pace you bring to this job directly affect whether that resolution happens fairly and on time. It's not glamorous work, but it's work that people genuinely depend on.

Pay and Benefits

• $63,500 annual salary
• Fully remote position with flexible scheduling
• Health, dental, and vision coverage
• Paid time off and company holidays
• Reimbursement support for relevant certifications and continuing education
• Technical equipment and remote-setup support provided

Who Tends to Do Well Here

Strong candidates for this role are comfortable sitting with ambiguity long enough to actually resolve it — not rushing a claim through just to clear a queue. Attention to detail matters more than speed, though eventually you'll need both. If you'd rather double-check something than guess, you'll probably fit in fine.