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Claim Reviewer Jobs (NOW HIRING)

Principal Financial Group

Claim Analyst 2

Des Moines, IA · On-site +1

$27.12 - $36.35/hr

What You'll Do As a Claim Analyst 2, you'll review, analyze, and make appropriate and accurate decisions on claims in accordance to the policy and state/federal law and regulations. * Analyze and ...

CCMSI

Multi-Line Claim Consultant

Reading, MA

$68K - $80K/yr

Review and maintain personal diary on claim system. * Client satisfaction. * Prepare reports ... detailing claim status, payments and reserves, as requested. * Compute disability rates in ...

CCMSI

Multi-Line Claim Consultant

Chicago, IL

$65K - $75K/yr

Review and maintain personal diary on claim system. * Prepare reports detailing claim status ... payments and reserves, as requested. * Compute disability rates in accordance with state laws.

CCMSI

Multi-Line Claim Consultant

Reading, MA · On-site

$68K - $80K/yr

Review and maintain personal diary on claim system. * Client satisfaction. * Prepare reports ... detailing claim status, payments and reserves, as requested. * Compute disability rates in ...

CCMSI

Multi-Line Claim Consultant

Chicago, IL

$65K - $75K/yr

Review and maintain personal diary on claim system. * Prepare reports detailing claim status ... payments and reserves, as requested. * Compute disability rates in accordance with state laws.

CCMSI

Multi-Line Claim Consultant

Reading, MA

$68K - $80K/yr

Review and maintain personal diary on claim system. * Client satisfaction. * Prepare reports ... detailing claim status, payments and reserves, as requested. * Compute disability rates in ...

CCMSI

Multi-Line Claim Consultant

Chicago, IL · On-site

$65K - $75K/yr

Review and maintain personal diary on claim system. * Prepare reports detailing claim status ... payments and reserves, as requested. * Compute disability rates in accordance with state laws.

Principal Financial Group

Claim Analyst 2

Des Moines, IA · On-site +1

$20.34 - $36.35/hr

What You'll Do As a Claim Analyst 2, you'll review, analyze, and make appropriate and accurate decisions on claims in accordance to the policy and state/federal law and regulations. * Analyze and ...

CCMSI

Workers' Compensation Claim Consultant

Irvine, CA

$80K - $90K/yr

Overview Workers' Compensation Claim Consultant Location: Irvine, CA (reporting remotely) Schedule ... Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices ...

CCMSI

Workers' Compensation Claim Consultant

Irvine, CA · On-site

$80K - $90K/yr

Overview Workers' Compensation Claim Consultant Location: Irvine, CA (reporting remotely) Schedule ... Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices ...

CCMSI

Workers' Compensation Claim Consultant

Concord, CA

$80K - $90K/yr

Overview Workers' Compensation Claim Consultant Location: Irvine, CA (reporting remotely) Schedule ... Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices ...

CCMSI

Workers' Compensation Claim Consultant

Irvine, CA

$80K - $90K/yr

Workers' Compensation Claim Consultant Location: Irvine, CA (reporting remotely) Schedule: 8:00am ... Review, approve or provide oversight of medical, legal, damage estimates and miscellaneous invoices ...

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All JobsClaim Reviewer Jobs

Claim Reviewer information

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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.
Claim Auditor Payment Integrity (44544)

Claim Auditor Payment Integrity (44544)

Neighborhood Health Plan of Rhode Island

Smithfield, RI • Remote

Full-time

Posted 8 days ago

Job description

The Claim Auditor in Payment Integrity will address problematic and complex audit assignments to identify claim overpayments in accordance with established billing and coding parameters. Claim payment accuracy will be recognized through sound audit review methods and practices, including but not limited to; claim payment evaluation, medical chart review, claim payment data analysis and assessment of established organizational contractual parameters. Independently analyzes, extracts, refines, and interprets claims data for actionable insights. The Auditor uses self-directed, decision making and problem solving that directly impacts financial outcomes and results.

Duties and Responsibilities:

Responsibilities include, but are not limited to:

  • Investigate potential over-utilization by performing audits thought pre and post claim payment.
  • Initiate and verify claims adjustments, maintain audit documentation, and prepare savings reports.
  • Identify new audit areas through data mining and performing sample audits.
  • Develops reports and deliverables for management and communicates with all levels of stakeholders.
  • Provide recommendations and collaborate with Payment Integrity team on audit outcomes, identified issues, recommended modifications to clinical medical policies, billing and reimbursement guidelines, and online provider manual.
  • Serve as contact with all operational areas relevant to Payment Integrity audit decisions.
  • Represent company in internal and external meetings/conference calls when needed to discuss audit results or perform coding education.
  • Performs other duties as assigned

Qualifications

Required:

  • Associate’s degree or equivalent three (3) years of claim review work experience to equate to the degree
  • American Academy of Professional Coder’s (AAPC) CPC certification or similar experience in medical records review, claims processing or utilization/case management in clinical practice or managed care organization
  • Fundamental knowledge of Medicare/Medicaid Guidelines
  • Experience with provider payment methodologies
  • Critical thinking and judgment/decision making skills
  • Solutions oriented-positive attitude
  • Independent problem solving-innovative thinker
  • Strong communication skills (written/verbal)
  • Excellent Customer Service skills
  • Ability to effectively prioritize and execute tasks in a high-pressure environment
  • Intermediate to Advanced skills in Microsoft Office (Word, Excel, Outlook)
  • Ability to work independently as well as part of a team

Preferred:

  • American Academy of Professional Coder’s (AAPC) COC and/or CIC
  • Data analytics experience
  • Knowledge of COGNOS reporting environment

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.  

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