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Health Insurance Medical Advisor Jobs (NOW HIRING)

GetScale

Health Insurance Sales Representative

Austin, TX · On-site

$50K - $75K/yr

You'll be a trusted advisor who helps people access essential healthcare. * Rapid Growth Potential ... Medical, dental, vision, life, disability, 401k. * Generous paid time off. * Paid volunteer day.

Traditions Health

Hospice Physician

Forsyth, IL · On-site

$200 - $250/hr

May also be called Medical Advisor, Chief Medical Physician, Chief Medical Officer, or a similar ... Full range of health insurance-medical (BCBS with 3 medical plan options), dental & vision.

Medix

Licensed Health Insurance Agent

Bloomington, MN · On-site

$25/hr

Licensed Health Insurance Agent (Remote - MN & WI) Position Type: Full-Time / Remote Pay: $25.00 ... medical and confidential records, verifying financial information, and working within departments ...

RemX

Be Seen First

Licensed Health Insurance Agents

Charlotte, NC · On-site

$20/hr (+ commission)

... Medical, dental, vision, 401(k), and PTO for full-time employees ✅ Remote work environment ✅ ... Active Health Insurance License in your state of residence * High school diploma or GED * Strong ...

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Health Insurance Medical Advisor information

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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:

Medical Health Insurance Claims Adjuster

Clearwater, FL • On-site

Integrity Marketing Group
See more jobs at Integrity Marketing Groupexternal

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 7 days ago

Integrity Marketing Group rating

7.7

Company rating: 7.7 out of 10

Based on 34 frontline employees who took The Breakroom Quiz

Job description

Health Insurance Claims Adjuster
Insurance Administrative Solutions
Clearwater, FL
About Insurance Administrative Solutions
Insurance Administrative Solutions, L.L.C. ("IAS"), an Integrity company headquartered in Clearwater, Florida, is a third-party administrator providing business process outsourcing for insurance carriers. Formed in 2002, IAS administers policies for insureds residing all across the United States.
Job Summary: Analyze medical claims to determine the extent of insurance carrier liability. Interpret contract benefits in accordance with specific claims processing guidelines.
Primary Responsibilities other duties may be assigned as necessary:
  • Examine/perform/research & make decisions necessary to properly adjudicate claims and written inquiries.
  • Receive, organize and make daily use of information regarding benefits, contract coverage, and policy decisions.
  • Interpret contract benefits in accordance with specific claim processing guidelines.
  • Coordinate daily workflow to coincide with check cycle days to meet all service guarantees.
  • Based on established guidelines and/or historical knowledge an adjuster will need to recognize red flags for potential fraud or waste and escalate accordingly.
  • Adjusters who handle the potential fraud or waste claims will investigate, track via clear and complete system notes and accurately report on each file/case in a timely manner.
  • Understand broad strategic concept of our business and link these to the day-to-day business functions of claims processing.
  • Maintain external contact with providers/agents/policyholders.

Primary Skills & Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
  • A high school diploma or GED equivalent
  • Minimum of 1 year proven health insurance claims adjudication experience.
  • Insurance background preferred; previous Medical/prescription claims preferred.
  • Experience with UB/institutional (CMS-1450) and HCFA/professional (CMS-1500) claims required.
  • Familiarity with medical terminology, procedures and diagnosis codes preferred.
  • Ability to read and interpret EOB's claim history, and excellent research skills.
  • Familiarity with Microsoft Office products; familiarity with Qiclink software a plus.
  • Ability to calculate deductible and co-insurance amounts.
  • Ability to adapt and respond to different types of people and tasks.
  • Excellent communication and documentation skills.
  • Ability to multi-task, prioritize, and manage time effectively and efficiently.
  • Reliable transportation and the ability to be punctual and dependable.

Benefits Available
  • We value flexibility and recognize the importance of work-life balance. This role will begin as fully onsite to support learning and team integration. As proficiency is demonstrated, hybrid work opportunities may be introduced, dependent on business needs and department practices.
  • Medical/Dental/Vision Insurance
  • 401(k) Retirement Plan
  • Paid Holidays
  • PTO
  • Community Service PTO
  • FSA/HSA
  • Life Insurance
  • Short-Term and Long-Term Disability

About Integrity
Integrity is one of the nation's leading independent distributors of life, health and wealth insurance products. With a strong insurtech focus, we embrace a broad and innovative approach to serving agents and clients alike. Integrity is driven by a singular purpose: to help people protect their life, health and wealth so they can prepare for the good days ahead.
Integrity offers you the opportunity to start a career in a family-like environment that is rewarding and cutting edge. Why? Because we put our people first! At Integrity, you can start a new career path at company you'll love, and we'll love you back. We're proud of the work we do and the culture we've built, where we celebrate your hard work and support you daily. Joining us means being part of a hyper-growth company with tons of professional opportunities for you to accelerate your career. Integrity offers our people a competitive compensation package, including benefits that make work more fun and give you and your family peace of mind.
Headquartered in Dallas, Texas, Integrity is committed to meeting Americans wherever they are - in person, over the phone or online. Integrity's employees support hundreds of thousands of independent agents who serve the needs of millions of clients nationwide. For more information, visit Integrity.com.
Integrity, LLC is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, national origin, disability, veteran status, or any other characteristic protected by federal, state, or local law. In addition, Integrity, LLC will provide reasonable accommodations for qualified individuals with disabilities.

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