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Claim Reviewer Jobs in Texas (NOW HIRING)

INSURICA, Inc

Senior Claim Consultant

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 ...

INSURICA, Inc

Senior Claim Consultant

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 ...

Zelis

Clinical Nurse Reviewer

Plano, TX · On-site

$59K - $75K/yr

Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. What You'll Do: * Conduct routine reviews of medical records and supporting ...

Zelis

Clinical Nurse Reviewer

Plano, TX · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest possible savings for clients. What You'll Do: * Conduct routine reviews of medical records and supporting ...

Public Storage

Claims Analyst

Frisco, TX · On-site

Participate in claim review meetings and escalate complex, high-exposure, or litigated claims as appropriate * Monitor support and team turnover at the TPA and report any issues or turnover to the ...

Public Storage

Claims Analyst

Frisco, TX

Participate in claim review meetings and escalate complex, high-exposure, or litigated claims as appropriate * Monitor support and team turnover at the TPA and report any issues or turnover to the ...

Public Storage

Claims Analyst

Frisco, TX

Participate in claim review meetings and escalate complex, high-exposure, or litigated claims as appropriate * Monitor support and team turnover at the TPA and report any issues or turnover to the ...

Public Storage

Claims Analyst

Frisco, TX

Participate in claim review meetings and escalate complex, high-exposure, or litigated claims as appropriate * Monitor support and team turnover at the TPA and report any issues or turnover to the ...

Zelis

Inpatient DRG Reviewer

Plano, TX · On-site

$79K - $99K/yr

Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What You Will Do: * Perform comprehensive inpatient DRG validation reviews to determine ...

E-Solutions

Claim Operator

Plano, TX · On-site

Review new submissions to ensure all required documentation and claim details are included File and manage shortage claims based on shortage investigation report, theft notification, and/or warehouse ...

Zelis

Inpatient DRG Reviewer

Plano, TX · On-site

Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients. What you will do: * Perform comprehensive inpatient DRG validation reviews to determine ...

Crawford and Company

Sr Claim Examiner-Liability

Dallas, TX · On-site

$49K - $89K/yr

In This Role, You'll: ️ Lead advanced claim investigations with independence ⚖️ Review coverage, determine liability, and drive fair resolutions Set reserves using sharp judgment and analytical ...

The Whiteside Agency

Cyber Claim Counsel

Houston, TX · On-site

$111K - $184K/yr

The BSI Claim Counsel team conducts thorough investigation, analysis, evaluation, and disposition ... Strengthen the ability to negotiate settlements/resolutions, review releases and settlement ...

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Claim Reviewer information

What is a claim reviewer?

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.

What does a claim reviewer do?

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.

What are the key skills and qualifications needed to thrive in the claim reviewer position?

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.

What are the most commonly searched types of Claim Reviewer jobs in Texas?

The most popular types of Claim Reviewer jobs in Texas are:

What are popular job titles related to Claim Reviewer jobs in Texas?

For Claim Reviewer jobs in Texas, the most frequently searched job titles are:

What job categories do people searching Claim Reviewer jobs in Texas look for?

The top searched job categories for Claim Reviewer jobs in Texas are:

Claim Reviewer jobs near you
Infographic showing various Claim Reviewer job openings in Texas as of August 2026, with employment types broken down into 81% Full Time, 17% Part Time, and 2% Contract. Highlights an 81% Physical, 6% Hybrid, and 13% Remote job distribution.

Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)

Addison, TX • On-site

ProHealth Home Health & Hospice
Fitness and Sports Centers • 201 - 500 employees
Learn more about ProHealth Home Health & Hospiceexternal

Full-time

Re-posted 9 days ago

Job description

JOB SUMMARY:

A licensed practical/vocational nurse who supports the region with organizing, reviewing, and submitting records for pre-claim review (PCR) for Review Choice Demonstration (RCD) to ensure affirmation. 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 billing.

QUALIFICATIONS:

1. Graduate of a state approved school of practical (vocational) nursing and current state license, or a multi-state license issued by a Nurse Licensure Compact (NLC) member state.

2. Two to four years home health experience preferred.

3. Knowledge of home health regulations required

4. Knowledge of Pre-Claim Review and Review Choice Demonstration preferred

5. Able to read, write and comprehend English.

6. Organized with a strong attention to detail.

7. Strong computer skills, HCHB experience is a plus.

RESPONSIBILITIES:

1. Understands and adheres to established Agency policies and procedures.

2. Works closely with Central Intake Department, Intake Manager, and/or Director of Intake, Billing Department, and Regional Director of Operations.

3. Understanding of home health practices and terminology.

4. Organizes, reviews, and processes pre-claim review workflow to ensure compliance with regulatory requirements and achieve claim affirmation for Medicare billing.

5. Reviews each Medicare patient episode to verify that all necessary components are present and coordinates with team members to resolve concerns that would lead to non-affirmation, claim rejection, or claim ADR.

6. Organizes submission packets and uploads to government processing provider and tracks status of submissions, affirmations, denials, non-affirmations, etc.

7. Responsible for entering tracking number (UTN) into electronic medical record and attaching affirmation letter to client’s medical record.

8. Serves as a role model for other colleagues by setting an example of high standards in dress, conduct, cooperation, and job performance.

9. Observes confidentiality and safeguards all patient related information.

10. Accepts responsibility for regular attendance and punctuality; fulfills job-related requirements without regard to time involved.

11. Develops a cooperative relationship and communicates effectively with all employees.

12. Reports problems and concerns to Supervisor.

13. Other duties as assigned by the Regional Director of Operations.

WORKING ENVIRONMENT:

Works indoors in Agency office/office space

JOB RELATIONSHIPS:

Supervised by: Regional Director of Operations

RISK EXPOSURE:

Low Risk

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

· Ability to participate in physical activity

· Ability to work for extended periods of time while sitting, standing and/or being involved in physical activity.

· Moderate lifting.

· Ability to do moderate bending, lifting, and standing on a regular basis.

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