Salisbury, NC · Remote
$19.25 - $24.25/hr
This person would be responsible for reviewing medical documentation and exposure records against claim filing criteria to determine if claimant has a compensable disease and a qualifying exposure ...
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Salisbury, NC · Remote
$19.25 - $24.25/hr
This person would be responsible for reviewing medical documentation and exposure records against claim filing criteria to determine if claimant has a compensable disease and a qualifying exposure ...
Glen Allen, VA · On-site
$76K - $77K/yr
Must demonstrate experience in Microsoft office and proficiency in claim management systems. EDUCATION/EXPERIENCE * High School Diploma and/or GED required. Associates Degree, strongly preferred.
Glen Allen, VA · On-site
$76K - $77K/yr
Must demonstrate experience in Microsoft office and proficiency in claim management systems. EDUCATION/EXPERIENCE * High School Diploma and/or GED required. Associates Degree, strongly preferred.
Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals. * Assess payment determinations using clinical information and established guidelines. * Evaluate ...
Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals. * Assess payment determinations using clinical information and established guidelines. * Evaluate ...
OR · Remote
Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals. * Assess payment determinations using clinical information and established guidelines. * Evaluate ...
OR · Remote
Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals. * Assess payment determinations using clinical information and established guidelines. * Evaluate ...
Plymouth, MN · On-site
$29 - $52/hr
The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a ...
Plymouth, MN · On-site
$29 - $52/hr
The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a ...
Plymouth, MN · Remote
$29 - $52/hr
The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a ...
Plymouth, MN · Remote
$29 - $52/hr
The clinical reviewer is responsible for documenting, researching state and federal guidelines and following internal procedures to determine the viability of the claim for further review in a ...
JOB SUMMARY: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using ...
JOB SUMMARY: Assist the Director of HIM in preparing claim audits, reviewing and recommending coding, revenue cycle and charge/billing changes on client hospital outpatient and Profee claims using ...
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Washington, DC · On-site
Claim Review Assessor Position Description AMENTUM Job Title: Senior Paralegal MEGA V Labor Category: Paralegal/Legal Assistant II General The September 11th Victim Compensation Fund ("VCF") was ...
Washington, DC · On-site
Claim Review Assessor Position Description AMENTUM Job Title: Senior Paralegal MEGA V Labor Category: Paralegal/Legal Assistant II General The September 11th Victim Compensation Fund ("VCF") was ...
Claim Review Assessor Position Description AMENTUM Job Title: Senior Paralegal MEGA V Labor Category: Paralegal/Legal Assistant II General The September 11th Victim Compensation Fund ("VCF") was ...
Claim Review Assessor Position Description AMENTUM Job Title: Senior Paralegal MEGA V Labor Category: Paralegal/Legal Assistant II General The September 11th Victim Compensation Fund ("VCF") was ...
$31.69/hr
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
$31.69/hr
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Washington, DC · On-site
$31.69/hr
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Washington, DC · On-site
$31.69/hr
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Washington, DC · On-site
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
Washington, DC · On-site
Working closely with respective claim review team leads and supervisors and, under the supervision of the Claims Manager, the Claim Review Assessor performs pre-screen, claim preparation ...
$62K - $105K/yr
Reviews claim and policy information to provide background for investigation. * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and ...
$62K - $105K/yr
Reviews claim and policy information to provide background for investigation. * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and ...
Los Angeles, CA · On-site
$57K - $83K/yr
Review and assess new medical-only claims to determine eligibility and coverage under workers ... Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss ...
Los Angeles, CA · On-site
$57K - $83K/yr
Review and assess new medical-only claims to determine eligibility and coverage under workers ... Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss ...
Los Angeles, CA · On-site
$57K - $80K/yr
Review and assess new medical-only claims to determine eligibility and coverage under workers ... Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss ...
Los Angeles, CA · On-site
$57K - $80K/yr
Review and assess new medical-only claims to determine eligibility and coverage under workers ... Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss ...
Richardson, TX · Remote
$63K - $81K/yr
Review all loss details for clarification of expenses versus indemnity on loss runs or closing ... Engages in field inspections for claim resolutions as needed * Periodic meetings with producers and ...
New
Richardson, TX · Remote
$63K - $81K/yr
Review all loss details for clarification of expenses versus indemnity on loss runs or closing ... Engages in field inspections for claim resolutions as needed * Periodic meetings with producers and ...
New
Richardson, TX · On-site
$95K - $110K/yr
Review all loss details for clarification of expenses versus indemnity on loss runs or closing ... Engages in field inspections for claim resolutions as needed * Periodic meetings with producers and ...
New
Richardson, TX · On-site
$95K - $110K/yr
Review all loss details for clarification of expenses versus indemnity on loss runs or closing ... Engages in field inspections for claim resolutions as needed * Periodic meetings with producers and ...
New
Los Angeles, CA · On-site
$72K - $123K/yr
Reviews claim and policy information to provide background for investigation. * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and ...
Los Angeles, CA · On-site
$72K - $123K/yr
Reviews claim and policy information to provide background for investigation. * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with insured, claimant and ...
$22.50 - $30/hr
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ensure compliance with regulations and verify necessary components are in place for affirmation and ...
$22.50 - $30/hr
The Pre-Claim Review Coordinator will review all Medicare episodes in assigned RCD state(s) to ensure compliance with regulations and verify necessary components are in place for affirmation and ...
$12.02 - $13.61
4% of jobs
$13.61 - $15.21
7% of jobs
$15.21 - $16.81
13% of jobs
$16.84 is the 25th percentile. Wages below this are outliers.
$16.81 - $18.40
26% of jobs
$18.40 - $20
22% of jobs
$20.57 is the 75th percentile. Wages above this are outliers.
$20 - $21.59
7% of jobs
$21.59 - $23.19
4% of jobs
$23.19 - $24.78
9% of jobs
$24.78 - $26.38
3% of jobs
$26.38 - $27.97
2% of jobs
$27.97 - $29.57
2% of jobs
$12
$19
$29
To thrive as a Claim Reviewer, you need a strong understanding of insurance policies, claims processing procedures, and attention to detail, often supported by relevant experience or education in insurance or a related field. Familiarity with claims management software, document imaging systems, and occasionally industry certifications (such as AIC or CPCU) are valuable assets. Strong analytical thinking, clear communication, and organizational skills help Claim Reviewers manage case loads and coordinate with different teams. Possessing these skills ensures accurate evaluations, timely processing, and maintains compliance and customer satisfaction in the claims process.
A Claim Reviewer is responsible for evaluating insurance claims to determine their validity and compliance with policy terms. They review documentation, investigate details, and assess whether claims should be approved, denied, or require further information. Claim Reviewers work closely with policyholders, healthcare providers, or other relevant parties to ensure accurate claim processing. Their role helps prevent fraud, control costs, and ensure fair payouts.
As a Claim Reviewer, your day typically involves reviewing submitted claims to verify accuracy, completeness, and compliance with policy guidelines. You'll analyze supporting documentation, collaborate with adjusters or other team members for additional information, and ensure decisions are well-documented and justified. Expect to handle multiple cases simultaneously, requiring good time management and organizational skills. Communication with customers or policyholders may occur when clarifications or follow-ups are needed. The work is often structured yet dynamic, offering meaningful variety and opportunities to develop knowledge within the insurance industry.
$19.25 - $24.25/hr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 27 days ago
Law firm in Salisbury, NC is looking for someone who has experience working for Verus Mass Tort Litigation Services.
This person would be responsible for reviewing medical documentation and exposure records against claim filing criteria to determine if claimant has a compensable disease and a qualifying exposure history. Communicating with the client to confirm the information prior to filing any claims, collect additional information for sworn exposure statements and affidavits where applicable. All qualifying claims must be filed in a timely manner to protect the statute of limitations for each claim. Responsible for following claims through the review process to cure any deficiencies that may arise in order to bring the claim to an approved status. Must update the data management system and document all work and client contact in the system.
