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Initial Reviewer Jobs (NOW HIRING)

MedReview

DRG Reviewer

Manhattan, NY · Remote

Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. * Collaborates with physician reviewers, as needed.

MedReview

DRG Reviewer

Manhattan, NY · On-site +1

$85K - $90K/yr

Demonstrates the ability to perform a comprehensive initial review as outlined in the standard operating procedures and departmental guides. * Collaborates with physician reviewers, as needed.

Elevance Health

Nurse Reviewer 1

Atlanta, GA · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Wilmington, DE · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Tampa, FL · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Miami, FL · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Elevance Health

Nurse Reviewer 1

Miami, FL · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical information presented meets medical necessity criteria or requires additional medical necessity review.

Resource Hub

Initial Billing Specialist

Indianapolis, IN · On-site

$18.50 - $24.75/hr

We are looking for an Initial Billing Specialist to join the team! Education and Experience: * High ... Reviews medical documentation to bill correct payors and products * Creates and mails insurance ...

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Initial Reviewer information

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$10

$29

$48

How much do initial reviewer jobs pay per hour?

As of Aug 19, 2026, the average hourly pay for initial reviewer in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.54 per hour, depending on experience, location, and employer.

What is an initial reviewer?

Initial Reviewers are professionals responsible for conducting the first assessment of documents, applications, or cases to ensure they meet specific criteria or guidelines. They play a crucial role in screening submissions by verifying completeness, accuracy, and compliance before forwarding them for further review or processing. Initial Reviewers are employed in various industries such as legal, healthcare, finance, and government, where they help streamline workflow and maintain quality control. Their work often involves attention to detail, adherence to protocols, and effective communication of findings.

What are the key skills and qualifications needed to thrive as an initial reviewer, and why are they important?

To thrive as an Initial Reviewer, you need strong analytical abilities, attention to detail, and relevant educational qualifications such as a bachelor's degree in a related field. Familiarity with case management systems, document review platforms, and regulatory compliance tools is often required. Excellent written communication, critical thinking, and organizational skills help you stand out in this position. These skills are crucial for accurately assessing and processing cases, ensuring compliance, and supporting efficient workflows.

What are some typical challenges faced by initial reviewers, and how can they be effectively managed?

Initial Reviewers often encounter challenges such as handling a high volume of submissions, maintaining consistency in evaluations, and adhering to strict deadlines. To manage these, it's important to develop strong organizational skills, stay updated on the latest guidelines, and communicate proactively with team members or supervisors when clarification is needed. Leveraging checklists and standard operating procedures can also help ensure accuracy and efficiency. Regular training and open feedback channels within the team further support continuous improvement and job satisfaction.

What is the difference between Initial Reviewer vs Document Reviewer?

AspectInitial ReviewerDocument Reviewer
Required CredentialsTypically a bachelor's degree, sometimes certifications in quality or complianceSimilar credentials, often with additional training in document management
Work EnvironmentOffice setting, often in healthcare, legal, or regulatory industriesOffice or remote, focusing on reviewing and verifying documents
Employer & Industry UsageUsed in healthcare, legal, finance, and regulatory sectorsCommon in legal, healthcare, and corporate compliance fields
Search & Comparison IntentUnderstanding entry-level review roles, responsibilities, and qualificationsClarifying differences in document review tasks and required skills

The main difference between an Initial Reviewer and a Document Reviewer lies in their specific roles. Initial Reviewers often perform preliminary assessments, while Document Reviewers focus on detailed verification of documents. Both roles require similar credentials and work in comparable environments, but their responsibilities differ based on the review stage and depth of analysis.

More about Initial Reviewer jobs

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

The most popular types of Initial Reviewer jobs are:

What job categories do people searching Initial Reviewer jobs look for?

The top searched job categories for Initial Reviewer jobs are:

Initial Reviewer jobs near you
Infographic showing various Initial Reviewer job openings in the United States as of August 2026, with employment types broken down into 2% As Needed, 84% Full Time, 11% Part Time, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.

Initial Clinical Reviewer - Remote - AZ

Blue Cross Blue Shield of Arizona

Phoenix, AZ • On-site, Remote

Full-time

Re-posted 13 days ago

Blue Cross Blue Shield Of Arizona rating

5.9

Company rating: 5.9 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

292nd of 310 rated insurance

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:
  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
  • Onsite: daily onsite requirement based on the essential functions of the job
  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.
This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
PURPOSE OF THE JOB
  • Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry.

QUALIFICATIONS
REQUIRED QUALIFICATIONS
Required Work Experience
  • 2 years of experience in clinical field of practice, health insurance, or other health care related field

Required Education
  • Associate's Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program
Required Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN.

Required Certifications
  • N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience
  • 3 years of experience in clinical field of practice, health insurance, or other health care related field
Preferred Education
  • Bachelor's Degree in Nursing or related field of study
Preferred Licenses
  • Active, current, and unrestricted license to practice in the State of Arizona (a state in the United States) as a Registered Nurse
Preferred Certifications
  • N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
  • Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person.

  • Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis.
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
  • Maintain complete and accurate records per department policy.
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations.
  • Explain to customers a variety of information concerning the organization's services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
  • Demonstrate ability to apply plan policies and procedures effectively.
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
  • When indicated to assist with team/project functions:
    • Collaborate with team to distribute workload/work tasks;
    • Monitor and report team tasks;
    • Communicate team issues and opportunities for improvement to supervisor/manager;
    • Support/mentor team members.
  • Participate in continuing education and current developments in the fields of medicine and managed care.
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements.
  • The position has an onsite expectation of 0 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements

  • Perform all other duties as assigned.

COMPETENCIES
REQUIRED COMPETENCIES
Required Job Skills
  • Intermediate PC proficiency
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones

Required Professional Competencies
  • Maintain confidentiality and privacy
  • Strong current clinical knowledge
  • Practice interpersonal and active listening skills to achieve customer satisfaction
  • Compose a variety of business correspondence
  • Interpret and translate policies, procedures, programs and guidelines
  • Capable of investigative and analytical research
  • Navigate, gather, input and maintain data records in multiple system applications
  • Follow and accept instruction and direction
  • Establish and maintain working relationships in a collaborative team environment
  • Organizational skills with the ability to prioritize tasks and work with multiple priorities
  • Independent and sound judgment with good problem solving skills

Required Leadership Experience and Competencies
  • Resolve conflicts
  • Represent BCBSAZ in the community

PREFERRED COMPETENCIES
Preferred Job Skills
  • Advanced PC proficiency
  • Knowledge of CPT-4 and ICD-9 coding

Preferred Professional Competencies
  • Knowledge of managed care, utilization management, and quality management
  • Working knowledge of McKesson InterQual® criteria

Preferred Leadership Experience and Competencies
  • N/A

Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.

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