• Job Title: Medical Claims Examiner (Remote / Part-Time)
• Job Type: Part-Time
• Schedule: Monday–Friday, 15–20 hours/week
• Location: Remote (occasional on-site meetings in Washington, DC may be required)
• Pay: Competitive hourly rate ($25/hr to $35/hr), commensurate with experience

JOB OVERVIEW:

We’re seeking experienced Registered Nurses (RNs) or medical professionals to serve as Medical Claims Examiners for a long-term government project focused on reviewing Paid Family and Medical Leave claims. This is a part-time, remote position with a flexible schedule during standard business hours.

QUALIFICATIONS:

• Active RN license or comparable clinical certification
• Minimum of 5 years of hands-on experience in clinical or general practice
• Strong knowledge of ICD-10 codes and treatment plans
• Familiarity with HIPAA and healthcare compliance regulations
• Strong written and verbal communication skills
• Proficient with Microsoft Office (Word, Excel, Outlook)
• Experience reviewing or evaluating medical records for insurance or disability claims is a plus

ADDITIONAL REQUIREMENTS:

• Must be a U.S. Citizen or authorized to work in the U.S.
• Must pass a background check and complete confidentiality training
• Must provide 3 professional references
• Must have personal equipment to work remotely (secure setup required)

• Review medical documentation for family/medical leave claims
• Apply ICD-10 knowledge to evaluate appropriate length of leave
• Assess medical certifications for compliance and accuracy
• Communicate findings clearly and document case actions in a system
• Flag suspicious claims for investigation
• Collaborate with internal teams via virtual platforms
• Provide written summaries and feedback to claim examiners