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Claims Review Jobs (NOW HIRING)

Davies

Claims Examiner

Description The Claims Examiner will focus on Stop Loss claim reviews for multiple clients. The focus of their daily activities will be claim reviews and reporting their findings to the client while ...

New

BerryDunn

Claims Data Analyst

Kapolei, HI

Support quality assurance reviews of reports, dashboards, analyses, documentation, and related work products. * Stay current with Medicaid payment integrity, program integrity, claims audit, improper ...

New

BerryDunn

Claims Data Analyst

Kapolei, HI

Support quality assurance reviews of reports, dashboards, analyses, documentation, and related work products. * Stay current with Medicaid payment integrity, program integrity, claims audit, improper ...

BerryDunn

Claims Data Analyst

Kapolei, HI · On-site

Support quality assurance reviews of reports, dashboards, analyses, documentation, and related work products. * Stay current with Medicaid payment integrity, program integrity, claims audit, improper ...

Holman, Inc.

Senior Claims Advocate

Mount Laurel, NJ · On-site

This role leads client-facing claims reviews and serves as a key advisor on claims outcomes and loss trends. Primary tasks the incumbent will perform: * Oversee the strategy and resolution of complex ...

CorVel Enterprise Claims, Inc.

Claims Specialist

Tampa, FL · Hybrid

$52K - $85K/yr

Adheres to client and carrier guidelines and participates in claims review as needed * Assists other claims professionals with more complex or problematic claims as necessary * Additional projects ...

Trustpoint.One

Claims Reviewer

Richmond, VA · On-site

$23/hr

Trustpoint.One is hiring Claims Reviewers for a temporary project ln Richmond, Virginia. This position will start in June 2026 and is anticipated to last 3 months. This is a temporary job.

Holman Inc

Senior Claims Advocate

Mount Laurel, NJ · On-site

This role leads client-facing claims reviews and serves as a key advisor on claims outcomes and loss trends. Primary tasks the incumbent will perform: * Oversee the strategy and resolution of complex ...

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How much do claims review jobs pay per year?

As of Aug 7, 2026, the average yearly pay for claims review in the United States is $61,600.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,000.00 and $65,500.00 per year, depending on experience, location, and employer.

What does a claims review do?

A claims review involves examining insurance claims to verify their accuracy, completeness, and compliance with policy terms. Claims reviewers assess documentation, determine claim validity, and identify potential errors or fraud, often using specialized software and industry knowledge. This process helps ensure proper claim processing and cost control for insurance companies.

Is claims review processing a stressful job?

Claims review is a detail-oriented role that can be stressful due to tight deadlines, high accuracy requirements, and the need to interpret complex policies. It often involves managing large volumes of claims and making critical decisions, which can contribute to job stress, especially during busy periods or when handling difficult cases.

What is the difference between Claims Review vs Claims Adjuster?

AspectClaims ReviewClaims Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires similar certifications, often with licensing depending on state
Work EnvironmentMostly office-based, reviewing claims electronically or on paperField and office-based, inspecting damages and interviewing claimants
Employer & IndustryInsurance companies, third-party administratorsInsurance companies, public adjusters, third-party administrators
Search & Comparison IntentOften compared for claims processing rolesRelated but involves more investigation and assessment

Claims Review specialists focus on evaluating insurance claims for accuracy and completeness, primarily working in an office setting. Claims Adjusters, on the other hand, investigate claims, assess damages, and determine payouts, often working in the field. Both roles require similar certifications and are integral to the insurance industry, but they differ in responsibilities and work environment.

Do you need a degree to be a claims review?

A degree is not always required to become a claims reviewer, but many employers prefer candidates with a high school diploma or equivalent. Relevant skills include attention to detail, knowledge of insurance policies, and experience with claims processing software; some roles may offer on-the-job training or certification programs.
More about Claims Review jobs
What cities are hiring for Claims Review jobs? Cities with the most Claims Review job openings:
What states have the most Claims Review jobs? States with the most job openings for Claims Review jobs include:
Claims Review jobs near you
Infographic showing various Claims Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $61,600 per year, or $29.6 per hour.

Director, Claims (Commercial-Self-Funded)

The Health Plan of West Virginia Inc

Wheeling, WV • On-site

Full-time

Re-posted 23 days ago

Job description

The Director of ASO and HMO claims is responsible for the management of the ASO and HMO products administered by The Health Plan. The Director assists the staff with education, communication, and problem solving. The director works closely with the Vice President of Operations. The Director manages daily operations of multiple levels of staff. Manages claims inventory with claims and stop loss managers to ensure productivity for analyst is at accepted levels. A Provides leadership both internally and externally.

Required:

  1. Bachelor’s Degree or equivalent experience.
  2. Experience in healthcare insurance operations.
  3. At least 5 years of previous claims leadership/management experience.
  4. Experience with medical claims payment, ICD-10, NDC, HCPCS.
  5. Strong analytical skills, including excell worksheets/formulas.
  6. Clear, concise verbal/written communication skills.
  7. Experience leading, formulating and delivering strategy, building strong connections with internal and external clients, customers, departments and teams.

Desired:

  1. Demonstrates integrity and ethical standards.
  2. Accountable with ability to deliver on commitments and take ownership for solving problems and creating solutions.
  3. Strong, positive leadership skills.
  4. Desire for continuous improvement and innovation with the ability to embrace change and drive new ideas into business solutions.
  5. Experience with Project Management.
  6. Stop Loss Reporting & Tracking Experience.     

Responsibilities:

  1. Directs all aspects of institutional and professional claims review for medical appropriateness and compliance with prompt pay regulations.
  2. Assists with the development, implementation, and updates to claims review procedures/criteria, physician and ancillary fee schedules and hospital contractual rates.
  3. Monitors check runs and monthly reports to detect potential problems or issues.
  4. Coordinates claim review activities with internal departments as well as participants on internal committees representing the claims department and formulates workflow between all departments.
  5. Responsible for interviewing and hiring of all staff and conducts annual employee performance reviews for direct reports.
  6. Monitors all daily activities with the assistance direct reports regarding claims processing/review, productivity, timeliness of payments and quality indicators of services.
  7. Conducts second reviews for Self Funded claims.
  8. Monitors and distributes reports as necessary.

8:00am - 5:00pm
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