Top 304 Claims reviewer Jobs in Remote

Shared Services Specialist
Private Health Management —Remote
- $26.44 - $31.25 an hour
- Remote
- Research
- Mid-level
- Bachelor's degree
- Dental insurance
- Paid time off
Quick Apply
7d
DRG Reviewer
Machinify —Remote
- $90,000 - $115,000 a year
- Remote
- Nursing
- HIPAA
- Mid-level
- Health savings account
- Health insurance
Quick Apply
DRG Reviewer
MedReview —Remote
- $85,000 - $90,000 a year
- Full-time
- Microsoft Outlook
- Computer literacy
- Mid-level
- Commuter assistance
- Health insurance
Quick Apply
Auto Reviewer Variable - Virtual & Desk
Alacrity Claims Solutions, LLC —Remote
- From $40,000 a year
- Overtime
- Background check
- Customer service
- Computer literacy
- Health savings account
- Health insurance
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Insurance Claims AI Reviewer
AuraOne Human Data —Remote
- Remote
- Bilingual
- CPA
- Writing skills
Quality Assessment Claims Specialist
Lyft —Nashville, TN
- $50,180 - $62,730 a year
- Remote
- Mid-level
- Continuous improvement
- Fair chance
- Commuter assistance
- Paid parental leave
1d
Claims Auditor, Reviewer and Coder
Planned Systems International, Inc. —Remote
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
- AD&D insurance
- Disability insurance
Physician Reviewer
MedReview —Remote
- $230,000 a year
- Full-time
- Remote
- Medicine
- 5 years
- BC/BE
Quick Apply
Quality Reviewer
Crawford & Company —Atlanta, GA
- Full-time
- Remote
- Writing skills
- Mid-level
- Analysis skills
- Paid parental leave
- Health savings account
Quick Apply
17h
Cardiology Clinical Reviewer
Cohere Health —Remote
- $120,000 - $135,000 a year
- Mid-level
- 3 years
- Travel
- Paid parental leave
- Health savings account
Quick Apply
Computational Biology AI Reviewer
AuraOne Human Data —Remote
- Remote
- Mid-level
- Doctor of Philosophy
- US work authorization
RN Reviewer
Cohere Health —Remote
- $33 - $35 an hour
- Weekends as needed
- Remote
- Google Workspace
- Nursing
- RN License
- Paid parental leave
- Health savings account
Quick Apply
Diagnostic Radiology- Medical Record Reviewer
Dane Street, LLC —Minneapolis, MN
- Remote
- BC/BE
- Senior level
- Radiology
Quick Apply
Business Analyst, Regulatory Reporting Solutions (Remote)
CVS Health —Washington, DC
- $43,888 - $102,081 a year
- Full-time
- Remote
- Mid-level
- Bachelor's degree
- Data entry
- Health insurance
- Dental insurance
Associate, Global Compliance External Engagement
Daiichi Sankyo —Basking Ridge, NJ
- $30 - $38 an hour
- Part-time
- Remote
- Sales
- Customer service
- Bachelor of Science
- Dental insurance
- 401(k)
2d
Licensed Psychologist, Peer Reviewer - Remote in Florida
UnitedHealth Group —Tampa, FL
- $91,700 - $163,700 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Access
- Microsoft Outlook
Remote Property Insurance Quality Assurance Analyst
Venture Underwriting LLC —Remote
- $18 an hour
- Full-time
- Remote
- English
- Research
- Mid-level
- Paid time off
- Flexible schedule
Quick Apply
Lead RN Reviewer
Cohere Health —Remote
- $35 - $37 an hour
- Remote
- Nursing
- RN License
- Continuous improvement
- Paid parental leave
- Health savings account
Quick Apply
Contributing Health Editorial Partners
Medclap Pvt. Ltd. —Remote
- $10 - $15 an hour
- Part-time
- Remote
- Entry level
- Flexible schedule
Quick Apply
Claims Analyst
Captrue Benefits LLC —Blaine, MN
- $52,000 - $62,000 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- HIPAA
- Dental insurance
7d

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Shared Services Specialist

Private Health Management -
Remote

Quick Apply

Job Details

$26.44 - $31.25 an hour
7 days ago

Benefits

Dental insurance
Paid time off
Vision insurance
401(k) matching

Qualifications

Medicare
Health insurance policy knowledge
Research
AI-driven automation

Full Job Description

About Private Health Management

Private Health Management guides patients and families through the chaos and complexity of serious medical care, for cancer and beyond. As an independent advocate and trusted partner during healthcare's most challenging moments, our team of experts work alongside physicians to orchestrate the best treatment, advocacy, and support to deliver measurably better outcomes.

Everyone deserves great care. We make sure they get it.

About the Role

Most healthcare organizations create specialists. PHM develops healthcare problem solvers.

We are hiring two Shared Services Specialists to help build a flexible, cross functional operating model across Partner Benefits, Provider Network, and Medical Records. Rather than working within one narrow specialty, you'll develop expertise across multiple Shared Services functions and flex where Care Teams and the business need support most.

The two hires will begin with different areas of focus. One will initially support Provider Network and Partner Benefits, while the other will initially support Provider Network and Medical Records. Over time, both will cross train into the third function, creating versatile operational specialists who can provide coverage during absences, respond to changing volumes, and help Care Teams and clients get answers faster.

What You'll Accomplish

Build working expertise across Provider Network, Partner Benefits, and Medical Records, ultimately providing reliable support across all three functions.
Improve turnaround times for Care Teams by delivering accurate, high quality operational support across multiple service lines.
Help create a more resilient Shared Services organization by flexing across functions as workloads, absences, and business needs change.
Become a trusted "quick hitter" who researches thoroughly, completes work accurately, and operates with increasing independence.

How You'll Spend Your Days

Provider Network

Research providers, verify credentials, and vet providers to ensure our provider database remains accurate and high quality.
Conduct provider outreach and maintain provider records and documentation.
Support ongoing provider data quality and operational requests from Care Teams.

Partner Benefits

Research and interpret commercial, employer sponsored, and Medicare health benefits.
Verify insurance coverage and explain benefit information to support Care Teams.
Document findings clearly and consistently while following established SOPs.

Medical Records

Support medical records collections by requesting records from provider offices, hospitals, and facilities; following up on outstanding requests; and documenting collection status clearly and accurately.
Coordinate with Care Teams and Medical Records colleagues to help prevent avoidable delays.

Shared Services Operations

Partner across Shared Services to flex between functions based on business demand.
Identify opportunities to improve workflows through technology, AI, and process enhancements.
Contribute to a collaborative, continuously improving operational team.

What You Bring to the Table

Required

Bachelor's degree strongly preferred.
Strong knowledge of commercial health insurance, employer sponsored plans, Medicare, and common healthcare benefit concepts, with the ability to interpret plan documents and navigate complex scenarios.
Exceptional research and critical thinking skills with the ability to synthesize information from multiple sources.
Outstanding attention to detail and a commitment to consistently accurate work.
Adaptability, learning agility, and enthusiasm for cross training across multiple healthcare functions.
Comfort using technology, AI tools, and multiple systems to improve efficiency and quality.

Nice to Have

Experience working in a health plan, provider office, hospital, healthcare navigation, care management, or similar healthcare environment.
Familiarity with provider research, credential verification, provider directories, healthcare databases or medical records collection.
Experience supporting authorizations, referrals, claims, or appeals.
Experience improving workflows through technology, AI, or process enhancements.

Compensation

The target hourly rate for this non-exempt position is $26.44–$31.25 per hour.

This hourly rate is only one part of a total compensation package that also includes health, dental, and vision benefits; 401(k) with match; paid time off; PHM for PHM (our services for you and your dependents); and other benefits. Individual pay may vary from the target range based on factors including market conditions, experience, location, and other relevant business considerations.

Location

This is a remote role requiring that you live in and physically perform all work in the United States.

Next Steps

Private Health Management is a remote company with employees across the United States. If your application is selected for next steps, you'll hear from a member of our recruiting team about the interview process, which may include conversations with the hiring manager, peers, and department leaders, conducted virtually by Zoom or phone.

PHM may use AI-enabled tools at certain points in the recruiting process to help us review candidates consistently and give more qualified applicants an opportunity to be considered beyond their resume. AI tools may support parts of the process, but they do not make hiring decisions. All hiring decisions are made by human reviewers.

Have a quick question about the role or our process? Email [email protected] or simply apply here.

Quick Apply

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