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Flexible Claim Reviewer Jobs (NOW HIRING)

Elevate Claims Solutions

File Reviewer

Indianapolis, IN · On-site

$14.75 - $17.75/hr

Hours are flexible within certain time parameters. This is a part time contract position that ... Reviews claim submissions from the field staff and audits work product for accuracy ...

AXA

Claims Manager, Casualty Reinsurance

Stamford, CT · On-site

Review claim files and conduct meetings with clients during the claim reviews and prepare claim ... With an innovative and flexible approach to risk solutions, we partner with those who move the ...

IFG Companies

Claim Assistant

Chapel Hill, NC · On-site

$50K - $52K/yr

Reviewing and handling of incoming and outgoing mail by identifying claim number and adjuster ... flexible spending, short-term and long-term disability insurance, life insurance, paid parental ...

AAA Auto Club Group

PIP Claim Rep I Michigan

$24.93 - $38.77/hr

Conduct thorough reviews of damages and determine the applicability of state law and other factors ... Benefits At ACG, we offer a comprehensive and flexible benefits package designed to support your ...

NACBA

Claim Attorney

Minneapolis, MN · On-site

$82 - $123/hr

... claims, reviewing and evaluating legal exposure, managing outside counsel and driving case ... Flexible work schedules and a great work/life balance * Opportunities for advancement in a ...

AAA Auto Club Group

PIP Claim Rep I Michigan

Fremont, MI · On-site +1

$24.93 - $38.77/hr

Conduct thorough reviews of damages and determine the applicability of state law and other factors ... Benefits At ACG, we offer a comprehensive and flexible benefits package designed to support your ...

NACBA

$82 - $123/hr

... claims, reviewing and evaluating legal exposure, managing outside counsel and driving case ... Flexible work schedules and a great work/life balance * Opportunities for advancement in a ...

Konare Law

Claim Attorney

Minneapolis, MN · On-site

$82 - $123/hr

... claims, reviewing and evaluating legal exposure, managing outside counsel and driving case ... Flexible work schedules and a great work/life balance * Opportunities for advancement in a ...

Machinify

Nurse Itemized Bill Reviewer (IBR Analyst)

$80K - $90K/yr

Recommend system enhancements and edits to improve claim review efficiency. * Comply with company ... Flexible and trusting environment where you'll feel empowered to do your best work The salary for ...

Arbella 56 Group

$145 - $165/hr

That means providing a great work environment, encouraging work/life balance, offering flexible ... Assign projects to the team after reviewing business requests and needs that emerge from business ...

Gainwell Technologies

WI · On-site

$78 - $85/hr

Actively cross‑train to perform reviews of multiple claim types to support a flexible workforce that meets client needs. What we're looking for * Active, unrestricted RN license in the United ...

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Flexible Claim Reviewer information

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How much do flexible claim reviewer jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for flexible claim reviewer in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.

What is the difference between Flexible Claim Reviewer vs Insurance Claims Processor?

AspectFlexible Claim ReviewerInsurance Claims Processor
Required CredentialsHigh school diploma or equivalent; some roles may prefer certifications in claims or insuranceHigh school diploma or equivalent; often requires familiarity with claims processing software
Work EnvironmentOffice setting, often remote or hybrid; involves reviewing claims and documentationOffice environment; processes insurance claims, verifies information, and inputs data
Employer & Industry UsageInsurance companies, third-party administrators, healthcare providersInsurance companies, healthcare providers, government agencies

Flexible Claim Reviewers focus on evaluating claims for accuracy and compliance, often with more flexibility in tasks. Insurance Claims Processors handle the processing and data entry of claims, typically following standardized procedures. Both roles require knowledge of insurance policies and claims procedures, but their daily tasks and responsibilities differ slightly.

What cities are hiring for Flexible Claim Reviewer jobs?

Cities with the most Flexible Claim Reviewer job openings:

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

The most popular types of Claim Reviewer jobs are:

What states have the most Flexible Claim Reviewer jobs?

States with the most job openings for Flexible Claim Reviewer jobs include:

Flexible Claim Reviewer jobs near you

Medical Reviewer (Pharmacist) - Remote CA

Gainwell Technologies

West Sacramento, CA • On-site, Remote

$100K - $140K/yr

Full-time

Medical, Life, Retirement, PTO

Posted 16 days ago

Gainwell Technologies rating

7.9

Company rating: 7.9 out of 10

Based on 84 frontline employees who took The Breakroom Quiz

130th of 247 rated software companies

Job description

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.
Summary
Gainwell Technologies is seeking a Medical Reviewer (Pharmacist) to provide pharmacy and clinical expertise supporting Medical Review Services for California healthcare programs. This role supports pharmacy review, claim adjudication, drug rebate activities, drug utilization review, Treatment Authorization Requests (TARs), and other Medical Review Services functions.
Your role in our mission
  • Perform pharmacy and medication-related clinical reviews.
  • Support pharmacy claim review and adjudication activities.
  • Provide clinical expertise for drug utilization review and drug-related authorization requests.
  • Support drug rebate and pharmacy program activities as assigned.
  • Review pharmacy documentation for compliance with applicable policies and coverage requirements.
  • Provide technical expertise and assistance related to pharmacy review.
  • Document findings and recommendations accurately and timely.
  • Collaborate with physicians, nurses, pharmacy teams, operations, and other healthcare professionals.
  • Maintain knowledge of applicable pharmacy policies and regulatory requirements.

What we're looking for
  • Current, non-expired pharmacist license from the State of California, in good standing.
  • Must not be under suspension from Medicare, Medicaid, or pharmacy practice in California.
  • Must not have been previously sanctioned for fraud or abuse.
  • Three (3) years of previous experience as a pharmacy consultant for a government or private-sector healthcare payer; or one (1) year of MMIS experience in a large state providing technical expertise and assistance for pharmacy review.
  • Strong oral and written communication skills.
  • Strong knowledge of pharmacy practices, medication review, and healthcare reimbursement processes.

What you should expect in this role
  • Full-time position.
  • Remote work environment.
  • Monday through Friday work schedule.
  • Work primarily from your home office while supporting Medical Review Services for California healthcare programs.
  • Spend the majority of your day reviewing pharmacy, clinical, claim, authorization, and supporting documentation.
  • Work independently while collaborating with physicians, pharmacists, nurses, other clinical specialists, operations teams, and business partners.
  • Navigate multiple computer systems and applications to complete reviews, document findings, and support timely determinations.
  • Maintain all professional licenses, certifications, and credentials required for the position in active, unrestricted, and good-standing status.
  • Maintain knowledge of applicable medical and pharmacy policies, coverage requirements, clinical standards, and regulatory guidelines.
  • Meet established quality, accuracy, productivity, and turnaround-time expectations.
  • Receive ongoing training and support related to program requirements, systems, policies, and medical review processes.
  • Travel requirement: 0-10%.

This position is being posted for pipeline purposes, and we welcome applications on an ongoing basis.
#LI-REMOTE
#LI-MA1
The pay range for this position is $100,000 - $140,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.
We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.
Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

What Gainwell Technologies employees say

Pay

Benefits

Hours and flexibility

Workplace

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About Gainwell Technologies

Sourced by ZipRecruiter

With Health and Cost outcomes that pierce Inequities and Impact Economies, the success of our Nation’s Federal Medicaid program is inextricably tied to the Prosperity of Communities, States and the Nation as a whole. We think that deserves Respect and a Commitment from Innovators who can help those who operate within and around health and human services evolve to meet their goals. At Gainwell, that’s our Sole focus. Built across more than Five Decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet Agencies, Health plans and MCOs where they are on their modernization journeys and propel them into the future of Healthcare. Equally important to our Expanding Technologies and Results. We bring ideas that bring policies to life.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Irving, TX, US

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