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Claim Reviewer Jobs (NOW HIRING)

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Reviewer I, Medical

Myrtle Beach, SC · On-site

Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring ...

Village Capital & Investment

VA Claim Processor

Hildale, UT · On-site

$13.75 - $17.50/hr

Review and process claims in accordance with VA guideline, ensuring that all information is ... Claim Review: Verify and review property and loan information to ensure eligibility for Liquidation ...

Village Capital & Investment

VA Claim Processor

Hildale, UT

$13.75 - $17.50/hr

Review and process claims in accordance with VA guideline, ensuring that all information is ... Claim Review: Verify and review property and loan information to ensure eligibility for Liquidation ...

Village Capital & Investment

VA Claim Processor

Hildale, UT · On-site

$13.75 - $17.50/hr

Review and process claims in accordance with VA guideline, ensuring that all information is ... Claim Review: Verify and review property and loan information to ensure eligibility for Liquidation ...

Commence

IDR Nurse Reviewer

Virginia Beach, VA · On-site

The Nurse Reviewer position is responsible for supporting and conducting reviews and determinations ... This position will be responsible for resolving claim disputes submitted by various parties, such ...

MSIG Holdings USA, Inc.

Claim Account Executive

Warren, NJ · On-site +1

$150K - $180K/yr

Coordinate claim reviews, large loss discussions, and issue resolution with adjusters, litigation teams, and internal partners. * Monitor adherence to service commitments and escalate issues ...

Zelis

Clinical Nurse Reviewer

Saint Petersburg, FL

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

Saint Petersburg, FL · 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 ...

Zelis

Clinical Nurse Reviewer

Saint Louis, MO

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 ...

Chubb

Lost Time Senior Claim Examiner

New Haven, CT

$33 - $44.75/hr

Reviews claim and policy information to provide background for the investigation * Conducts 3-part ongoing investigations, obtaining facts and taking statements as necessary, with the insured ...

Zelis

Clinical Nurse Reviewer

Morristown, NJ

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

Atlanta, GA

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

Boston, MA

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

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 ...

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How much do claim reviewer jobs pay per hour?

As of Jun 26, 2026, the average hourly pay for claim reviewer in the United States is $19.85, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.63 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Claim Reviewer position, and why are they important?

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.

How to get a job as a claims examiner?

To become a claims examiner, candidates typically need a high school diploma or equivalent, with some roles requiring an associate's or bachelor's degree in fields like insurance, finance, or healthcare. Relevant skills include attention to detail, analytical thinking, and knowledge of insurance policies; certifications such as the Certified Claims Professional (CCP) can enhance prospects. Job opportunities are often found through online job boards, insurance companies, and staffing agencies, with roles available in office environments and sometimes remote work.

What is a Claim Reviewer job?

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 typical workday look like for a Claim Reviewer?

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 job makes $10,000 a month without a degree?

A claim reviewer can potentially earn $10,000 a month through experience and specialized knowledge, especially in high-demand insurance or healthcare sectors. Success in such roles often depends on strong analytical skills, attention to detail, and familiarity with industry-specific software, with some positions offering remote work and flexible schedules.

What does a claims reviewer do?

A claims reviewer evaluates insurance claims to determine their validity and ensure they comply with policy terms. They analyze documentation, verify information, and make decisions on claim approval or denial, often using specialized software and following company guidelines.

What jobs pay 2000 a day?

Claim reviewers typically do not earn $2,000 a day; their salaries are usually based on annual or hourly rates. High-paying roles in finance, consulting, or specialized medical fields can reach such daily earnings, often requiring advanced skills, certifications, or significant experience. These roles may involve complex decision-making, analysis, or client management, and often operate in high-stakes environments.
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Claim Reviewer jobs near you
Infographic showing various Claim Reviewer job openings in the United States as of June 2026, with employment types broken down into 97% Full Time, 2% Part Time, and 1% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $41,287 per year, or $19.8 per hour.
(LPN) Pre-Claim Review Coordinator - ProHealth Home Health and Hospice (Dallas, TX)

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

ProHealth Home Health & Hospice

Addison, TX • On-site

$25.25 - $33.50/hr

Full-time

Posted 4 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.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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