ZipRecruiter

Log In

1

Health Insurance Medical Advisor Jobs (NOW HIRING)

Medix

Health Insurance Specialist

Erie, PA · On-site

$25/hr

... health insurance dispute resolution . (Candidates without direct claims dispute or appeals ... Demonstrated track record of reviewing complex medical claims, Explanation of Benefits (EOBs ...

Elizabeth Rook Insurance

Insurance Advisor

Covington, TN · On-site

$35K - $50K/yr (+ commission)

As an Insurance Advisor, you will be responsible for providing exceptional customer service to our ... Health Insurance * Retirement Plan **matching contributions after second year** * Holidays * Paid ...

HealthMarkets Insurance Agency

Insurance Advisor

Tulsa, OK · Remote

$50K - $120K/yr

HealthMarkets is a technology-enabled health insurance agency delivering high-touch, customized health and supplemental insurance solutions to individuals, families and small businesses. Millions of ...

HealthMarkets Insurance Agency

Insurance Advisor

Cody, WY · Remote

$50K - $120K/yr

HealthMarkets is a technology-enabled health insurance agency delivering high-touch, customized health and supplemental insurance solutions to individuals, families and small businesses. Millions of ...

HealthMarkets Insurance Agency

Insurance Advisor

Provo, UT · Remote

$50K - $120K/yr

HealthMarkets is a technology-enabled health insurance agency delivering high-touch, customized health and supplemental insurance solutions to individuals, families and small businesses. Millions of ...

previous pagenext page

Showing results 21-40

All JobsHealthcare JobsDoctors JobsHealth Insurance Medical Advisor Jobs

Health Insurance Medical Advisor information

See salary details

$15

$53

$98

How much do health insurance medical advisor jobs pay per hour?

As of Sep 10, 2026, the average hourly pay for health insurance medical advisor in the United States is $53.85, according to ZipRecruiter salary data. Most workers in this role earn between $20.19 and $78.37 per hour, depending on experience, location, and employer.

What is a health insurance medical advisor?

A Health Insurance Medical Advisor is a healthcare professional, often a physician or nurse, who evaluates medical claims, provides guidance on coverage decisions, and ensures that treatments are medically necessary and comply with policy guidelines. They work for health insurance companies to review patient cases, collaborate with healthcare providers, and help manage costs by making recommendations based on clinical standards. Their expertise helps balance quality patient care with the responsible use of insurance resources. Health Insurance Medical Advisors also assist with appeals and provide input on policy development.

What are the key skills and qualifications needed to thrive as a health insurance medical advisor?

To thrive as a Health Insurance Medical Advisor, you need a solid background in medicine (MD, DO, RN, or similar qualification), knowledge of medical guidelines, and experience with insurance processes. Familiarity with claims management systems, ICD-10 coding, and utilization review tools is typically required, along with certifications like CMAS or URAC accreditation. Strong analytical skills, attention to detail, and effective communication are crucial for explaining decisions and collaborating with healthcare providers. These skills ensure accurate claim evaluations, compliance with regulations, and fair outcomes for both insurers and patients.

What are some common challenges health insurance medical advisors face when balancing clinical judgment with insurance policies?

Health Insurance Medical Advisors often encounter the challenge of aligning their clinical expertise with the specific guidelines and coverage limitations of insurance plans. While their medical background enables them to assess the medical necessity of treatments, they must also ensure that recommendations comply with policy terms and regulatory requirements. This can require clear communication with both healthcare providers and policyholders to explain decisions and advocate for appropriate care, all while navigating administrative processes and maintaining impartiality.

What is the difference between Health Insurance Medical Advisor vs Health Insurance Underwriter?

AspectHealth Insurance Medical AdvisorHealth Insurance Underwriter
CredentialsMedical degree, relevant certificationsBackground in finance, risk assessment, certifications
Work EnvironmentHealthcare settings, insurance companiesInsurance companies, risk assessment teams
Primary RoleAssess medical claims, provide medical expertiseEvaluate risks, determine policy eligibility and premiums

While both roles are integral to health insurance, the Health Insurance Medical Advisor focuses on medical assessments and claims, whereas the Health Insurance Underwriter evaluates risks and sets policy terms. Understanding these differences helps clarify career paths and employer expectations in the health insurance industry.

What are popular job titles related to Health Insurance Medical Advisor jobs?

For Health Insurance Medical Advisor jobs, the most frequently searched job titles are:

Health Insurance Specialist

Erie, PA • On-site

Medix
Recruiting and Staffing Services • 1 - 5K employees
Learn more about Medixexternal

$25/hr

Full-time

Re-posted 13 days ago

Key responsibilities

  • Evaluate and adjudicate complex out-of-network payment disputes between healthcare providers and health plans in strict accordance with No Surprises Act guidelines

  • Analyze submitted evidence, fee benchmarks, and documentation from both provider and payer to select the appropriate final payment offer

  • Maintain precise, audit-ready case records within federal government portals

Job description

Job Title: Determination Specialist
Position Type: Full-Time / Contract-to-Hire (High growth potential)
Location: Remote (IT Equipment Issued)
Industry: Healthcare / Federal Contracting (GSA)
About the Role
Are you an analytical healthcare claims specialist with direct experience handling payment disputes, provider appeals, or billing arbitrations? We are seeking an experienced Determination Specialist to join our team supporting a federal Independent Dispute Resolution Entity (IDRE) program.
Under the federal No Surprises Act, an IDRE is certified to resolve out-of-network payment disputes between healthcare providers and health plans. In this role, you will leverage your specialized background in provider dispute resolution to evaluate complex documentation, apply federal regulatory criteria, and render final, binding payment determinations for emergency services, facility care, and air ambulance cases.
This position requires demonstrated expertise in healthcare dispute resolution, claims appeals, or out-of-network payment adjudication. If you thrive in an ever-changing environment, excel at solving complex problems in the "grey," and want to apply your dispute experience to high-profile federal oversight, we want to hear from you.
Key Responsibilities
  • Dispute Adjudication: Evaluate and adjudicate complex out-of-network payment disputes between healthcare providers and health plans in strict accordance with No Surprises Act guidelines.
  • Binding Payment Determinations: Analyze submitted evidence, fee benchmarks, and documentation from both provider and payer to select the appropriate final payment offer.
  • Regulatory Compliance: Interpret complex federal and state billing regulations to ensure every dispute determination is legally sound, impartial, and compliant.
  • Case Documentation & Data Entry: Maintain precise, audit-ready case records within federal government portals.
  • Performance Metrics: Manage a active portfolio of dispute cases, meeting strict turnaround deadlines and high quality-assurance standards.

Qualifications & Requirements
Essential Experience (Required):
  • Direct Dispute & Appeals Background: Minimum 2+ years of experience specifically in provider payment disputes, claims appeals, out-of-network reimbursement, or health insurance dispute resolution. (Candidates without direct claims dispute or appeals experience will not be considered.)
  • Analytical Expertise: Demonstrated track record of reviewing complex medical claims, Explanation of Benefits (EOBs), contract terms, and regulatory guidance to solve payment discrepancies.
  • Technical Skills: Advanced data entry skills and proficiency in Microsoft Office (specifically Excel for data analysis and case tracking).
  • Compliance & Screening: Must clear all background checks and meet strict federal conflict-of-interest requirements.

Preferred Knowledge:
  • Education: Bachelor's degree or equivalent combination of specialized dispute-resolution experience.
  • Regulatory Knowledge: In-depth understanding of the Independent Dispute Resolution (IDR) process, the No Surprises Act, and varied plan types (Commercial, Medicare, Medicaid, Self-Funded/ERISA).

Core Competencies & Soft Skills
  • Mastery in Ambiguity: Ability to make sound, independent decisions in complex cases where guidelines require nuanced interpretation.
  • Precision & Detail: High level of accuracy when evaluating conflicting evidence and numerical data from opposing parties.
  • High-Volume Execution: Capacity to maintain quality and speed in a fast-paced environment with a heavy backlog of cases.

What We Offer & Why You Should Join
  • Massive Growth Opportunity: Backed by steady case volume and 50+ open FTE positions, offering exceptional stability and conversion to permanent roles for strong performers.
  • Equipment Provided: Complete IT equipment package provided upon hire.
  • High-Impact Work: Utilize your niche expertise in payment disputes on a vital federal GSA program shaping national healthcare reimbursement standards.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).
* As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients
Medix Staffing Solutions logo

About Medix Staffing Solutions

Sourced by ZipRecruiter

Since 2001, we’ve been dedicated to helping you achieve your goals. Medix was created to become a leading provider of workforce solutions for clients and candidates across the healthcare and life sciences industries. Today, we are that leader. Headquartered in Chicago, we have 23 offices across the United States, and staff talent around the world. Medix is committed to fulfilling our core purpose as an organization: to positively impact the lives of our talent, clients, and teammates through employment, philanthropy, and opportunity. The combination of purpose and values has nurtured our thriving culture that encourages our internal team to excel at work and in everyday life.

Industry

Recruiting and staffing services

Company size

1,001 - 5,000 Employees

Headquarters location

Chicago, IL, US

View All Medix Staffing Solutions Jobs

Apply