1

Claim File Reviewer Jobs (NOW HIRING)

Perform periodic claim file reviews and audits to ensure data integrity, regulatory compliance, and adherence to company claims procedures. * Support company safety and risk management initiatives ...

New

Outside Property Claim Manager

Largo, MD · Remote

$104K - $171K/yr

Conduct quality file reviews per office/ best practices guidelines. * Conduct ride-along inspections/ reinspections with claim professionals to provide coaching and feedback. * Establish/follow up on ...

Showing results 41-60

Claim File Reviewer information

See salary details

$13

$21

$28

How much do claim file reviewer jobs pay per hour?

As of Sep 3, 2026, the average hourly pay for claim file reviewer in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.

What is a claim file reviewer?

Claim File Reviewers are professionals who evaluate insurance claims to ensure their accuracy, completeness, and compliance with policy guidelines. They review submitted documents, assess the validity of claims, and may request additional information or clarification from claimants. Their work helps insurance companies detect errors, prevent fraud, and make fair decisions regarding claim approvals or denials. Claim File Reviewers play a crucial role in maintaining the integrity of the claims process and upholding industry standards.

What are some common challenges claim file reviewers face when evaluating complex insurance claims?

Claim File Reviewers often encounter complex cases that require careful analysis of policy details, medical records, and legal documentation. A key challenge is balancing efficiency with thoroughness, as missing critical information can lead to incorrect claim decisions. Additionally, reviewers must navigate tight deadlines while collaborating closely with adjusters, legal teams, and sometimes customers to resolve discrepancies. Staying updated on changing regulations and company policies is also essential to ensure accurate and compliant reviews.

What are the key skills and qualifications needed to thrive as a claim file reviewer, and why are they important?

To thrive as a Claim File Reviewer, you need strong attention to detail, analytical skills, and a solid understanding of insurance policies or claims processing, typically backed by relevant experience or a degree in a related field. Familiarity with claims management software, document management systems, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Excellent organizational skills, discretion, and effective communication are valuable soft skills for accuracy and collaboration. These capabilities ensure thorough and compliant claim reviews, minimizing errors and supporting fair outcomes for all parties.

What is the difference between Claim File Reviewer vs Claims Adjuster?

AspectClaim File ReviewerClaims Adjuster
Required CredentialsHigh school diploma or equivalent; some roles may require insurance certificationsHigh school diploma; insurance licenses or certifications often preferred
Work EnvironmentOffice setting, reviewing claim files and documentationOffice or field, investigating claims and interacting with claimants
Industry UsageInsurance companies, third-party administratorsInsurance companies, independent adjusting firms
Search & Comparison IntentUnderstanding role differences, job requirements, and career pathsComparing responsibilities, credentials, and work scope

The Claim File Reviewer primarily focuses on reviewing and verifying claim documentation within an office environment, often requiring minimal certifications. In contrast, Claims Adjusters investigate claims, sometimes in the field, and may hold insurance licenses. Both roles are integral to the insurance industry but differ in scope, responsibilities, and required credentials.

More about Claim File Reviewer jobs

What states have the most Claim File Reviewer jobs?

States with the most job openings for Claim File Reviewer jobs include:

Infographic showing various Claim File Reviewer job openings in the United States as of August 2026, with employment types broken down into 79% Full Time, 16% Part Time, 1% Temporary, 3% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $43,783 per year, or $21 per hour.

APD Claim Representative I - Meemic

AAA Auto Club Group

Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.


AAA The Auto Club Group rating

7.4

Company rating: 7.4 out of 10

Based on 283 frontline employees who took The Breakroom Quiz

236th of 315 rated insurance


Job description

Job Type:
Full time
Exempt/Non Exempt:
Hourly
Job Description:
Location Details:
Remote
Position Schedule / Shift:
Monday-Friday 9am-6pm ET
Position Summary:
As an Auto Claim Representative I, you will be responsible for investigating, evaluating, and resolving low complexity automobile physical damage claims in accordance with company policies and applicable regulations. Reviews claim information, assesses vehicle damage, determines coverage, and coordinates repairs or settlements.
Key Responsibilities:
Claim handling responsibilities will include the following:
  • Reviewing assigned claims
  • Contacting the insured and other affected parties
  • Setting expectations for the remainder of the claim process
  • Initiating documentation in the claim handling system
  • Complete complex coverage analysis
  • Ensure all possible policyholder benefits are identified
  • Create additional sub-claims if needed
  • Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential.
  • Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim.
  • Evaluate the financial value of the loss
  • Approve payments for the appropriate parties accordingly
  • Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit).
  • Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system
  • Utilize strong negotiating skills.

Employees assigned to Auto Physical Damage ("APD") claim unit will handle moderately complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage. If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. Additional responsibilities may include the following: determining cause of damage, establishing liability, identifying subrogation potential, monitoring repairs and approving car rental expense. May handle simple APD Litigation cases.
Qualifications:
Required
Education (including minimum education and any licensing/certifications):
  • High school diploma or equivalent
  • Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience
  • In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate state
  • A valid driver's license is required if the primary responsibilities of the role involve conducting in-person inspections or frequent in-person meetings with members

Experience:
  • Six months of experience or equivalent training in the following:
  • negotiation of claim settlements
  • securing and evaluating evidence
  • preparing manual and electronic estimates
  • subrogation claims-identifying recovery opportunities

Knowledge of:
Advanced knowledge of:
  • Essential Insurance Act (Michigan)
  • Fair Trade Practices Act as it relates to claims
  • subrogation procedures and processes
  • intercompany arbitration

Ability to:
  • handle claims to the line Claim Handling Standards
  • follow and apply ACG Claim policies, procedures and guidelines
  • work within assigned ACG Claim systems including basic PC software
  • perform basic claim file review and investigations
  • demonstrate effective communication skills (verbal and written)
  • demonstrate customer service skills by building and maintaining relationships with insured/claimants while exhibiting understanding of their problems and responding to questions and concerns
  • analyze and solve problems while demonstrating sound decision-making skills
  • prioritize claim related functions
  • process time sensitive data and information from multiple sources
  • manage time, organize and plan workload and responsibilities
  • safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.
  • research analyze and interpret subrogation laws in various states
  • travel outside of assigned territory which may involve overnight stay
  • relocate, work evenings or weekends

Preferred
Education:
  • Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience
  • Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, associate in management or equivalent
  • CPCU coursework or designation
  • I-Car ProLevel training
  • CCC training
  • XACT ware Training

Work Environment:
This position is currently able to work remotely from a home office location for day-to-day operations unless occasional travel for meetings, collaborative activities, or team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.
Compensation & Benefits Overview:
ACG complies with all applicable state and local laws regarding required benefits (including PTO, paid sick leave, etc.).
Compensation
A APD Claim Representative I earns a competitive hourly salary of $25.00-$30.00 along with the opportunity for an annual company bonus incentive.
Benefits
At ACG, we offer a comprehensive and flexible benefits package designed to support your health, financial well-being, and professional growth.
Health & Wellness
  • Medical plans with multiple coverage options, including HSA eligibility.
  • Prescription drug coverage.
  • Dental and vision benefits.
  • Employee Assistance Program (confidential support services).

Financial Protection & Insurance
  • Company-paid basic life insurance.
  • Optional supplemental life insurance and dependent coverage.
  • Short-term and long-term disability coverage.
  • Critical illness, accident, and pet insurance options.

Retirement & Savings
  • 401(k) plan to support long-term financial goals.
    • 3% automatic deferral upon eligibility; may contribute 1% to 50% of eligible earnings, either pre or post tax.
    • Company match of 50% paid on employee contributions up to 6% of pay, payable to employees following the end of the year; immediate vesting.
    • Additional company contribution of 4% of pay each pay day into your account; 100% vested after three (3) years of service.
  • Health Savings Account (HSA) and Flexible Spending Accounts (FSA) options.

Time Off & Leave
  • Paid Time Off (PTO): Accrual-based, increases with tenure, eligible at 90 days of employment.
  • Full-time new employees will receive up to 12 PTO days annually; accrual based on start date and may include additional PTO based on role and/or state & local requirements.
  • Part-time employee PTO hours are calculated based upon the standard weekly hours the employee is scheduled to work and will accrue at a minimum of 3 hours per month.
  • Paid holidays:
    • Full-time employees are eligible for 10 company-paid holidays annually, in addition to 1 mental health day, 2 floating holidays, and 1 volunteer day. Holidays will vary by business schedules
    • Part-time employees are eligible for 8 company-paid holidays annually, in addition to 1 mental health day and 2 floating holidays. Holidays will vary by business unit schedules.
  • Paid leave programs, including parental, bereavement, jury duty, and military leave.

Career Growth & Education
  • Tuition assistance (up to $5,250 annually; 80% covered by ACG).
  • Professional certification support with 100% reimbursement for eligible programs.
  • Opportunities for career development and advancement.

Additional Perks
  • Complimentary AAA membership with roadside assistance and travel discounts.
  • Adoption assistance program.

Job Posting Period:
This position is expected to remain posted through September 3, 2026; however, it may close at any time once a qualified candidate pool is identified.
#LI-AH2
Who We Are
Become a part of something bigger.
The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.
By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.
And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.
We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.
To learn more about AAA The Auto Club Group visit www.aaa.com
Important Note:
ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.
The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.
The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.
Regular and reliable attendance is essential for the function of this job.
AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.

What AAA The Auto Club Group employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom


American Automobile Association logo

About American Automobile Association

Sourced by ZipRecruiter

The American Automobile Association (AAA), headquartered in Heathrow, Florida, USA, is a reputable force in the automotive and insurance industry. Originating in 1902, it began as a coalition of motor clubs with the common goal of providing better roads and travel conditions for motorists. Today, AAA is a comprehensive, multifaceted organization that offers a range of services, including roadside assistance, auto repair services, travel agency services, and diverse insurance products - Auto, Home, Life and more. A significant principle for AAA is to continuously deliver value to their 61 million members through safety, security and peace of mind. The company's mission and core values focus on championing its members' rights and interests, advocating innovation, integrity, teamwork and respect.

Industry

Non-profits

Company size

10,000+ Employees

Headquarters location

Heathrow, FL, US

Year founded

1902

Social media