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Insurance Claim File Review Jobs in Texas (NOW HIRING)

Chubb

ESIS Claims Specialist, AGL

Houston, TX · On-site

May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current ...

Chubb

ESIS Claims Specialist, AGL

Houston, TX · On-site

May participate in claim file reviews and audits with customer/insured and broker. Administers benefits timely and appropriately. Maintains control of claim's resolution process to minimize current ...

Ccfs

Risk Claims Manager

Houston, TX · Remote

$85K - $95K/yr

Work with insurance companies to set claim reserves. * Identify claims that require escalation to ... claim file reviews as requested. * Ensure the company takes appropriate measures to minimize claim ...

P4N Solutions

Be Seen First

Logistic Claim Operator

Plano, TX · On-site

$19 - $23/hr

Review new submissions to ensure all required documentation and claim details are included * File and manage shortage claims based on shortage investigation report, theft notification, and/or ...

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Insurance Claim File Review information

See Texas salary details

$9

$20

$42

How much do insurance claim file review jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for insurance claim file review in Texas is $20.36, according to ZipRecruiter salary data. Most workers in this role earn between $15.91 and $23.94 per hour, depending on experience, location, and employer.

What is an insurance claim file review?

An Insurance Claim File Review is a detailed evaluation of insurance claim documents and files to ensure accuracy, compliance, and proper processing. Professionals in this role review submitted claims, verify information, assess the validity of the claim, and determine if all required documentation is present. They may also check for potential fraud, ensure adherence to company policies, and make recommendations regarding claim approval or denial. This process is critical to maintaining the integrity of the claims system and minimizing losses for the insurance provider.

What is the difference between Insurance Claim File Review vs Insurance Claims Adjuster?

AspectInsurance Claim File ReviewInsurance Claims Adjuster
Primary RoleReview and analyze insurance claim files for accuracy and completenessInvestigate, evaluate, and settle insurance claims
Required CredentialsTypically claims or insurance certifications, sometimes a background in insurance or claims processingAdjuster license, insurance certifications, relevant experience
Work EnvironmentOffice-based, primarily reviewing documents and dataField and office work, including site visits and interviews
Industry UsageCommon in insurance companies, third-party claims review firmsWidely used in insurance companies, claims departments

While both roles involve working with insurance claims, the Insurance Claim File Review focuses on analyzing claim documentation for accuracy, whereas the Insurance Claims Adjuster actively investigates and settles claims. The review role is more document-centric, often office-based, and requires specific certifications, while adjusters may work in the field and handle the entire claims process.

What are the key skills and qualifications needed to thrive as an insurance claim file reviewer?

To thrive as an Insurance Claim File Reviewer, you need a keen understanding of insurance policies, claims processes, and regulatory compliance, often backed by relevant experience or an insurance-related certification. Familiarity with claims management systems, document management software, and industry-specific databases is typical for the role. Attention to detail, analytical thinking, and strong written communication are vital soft skills that help ensure accuracy and clarity in claim assessments. These skills are crucial for efficiently evaluating claims, reducing errors, and ensuring fair and prompt claim resolutions.

What are some common challenges faced by professionals in insurance claim file review, and how can these be managed effectively?

Professionals in Insurance Claim File Review often encounter challenges such as interpreting complex policy language, managing large caseloads, and ensuring compliance with constantly evolving regulations. Staying organized and leveraging claim management software can help streamline the review process and reduce errors. Regular training and collaboration with legal, medical, and adjuster teams also play a key role in addressing ambiguities and maintaining accuracy in claim determinations.
What are popular job titles related to Insurance Claim File Review jobs in Texas? For Insurance Claim File Review jobs in Texas, the most frequently searched job titles are:
What job categories do people searching Insurance Claim File Review jobs in Texas look for? The top searched job categories for Insurance Claim File Review jobs in Texas are:
Insurance Claim File Review jobs near you
Infographic showing various Insurance Claim File Review job openings in Texas as of August 2026, with employment types broken down into 80% Full Time, and 20% Contract. Highlights an 80% In-person, and 20% Hybrid job distribution, with an average salary of $42,352 per year, or $20.4 per hour.

Claim Adjuster - General Liability and Product Liability | Jurisdiction: Mutli State | Licensing: Re

Sedgwick

Frisco, TX • On-site

$65K - $80K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

This job post has expired today. Applications are no longer accepted.

Sedgwick rating

7.6

Company rating: 7.6 out of 10

Based on 320 frontline employees who took The Breakroom Quiz

209th of 303 rated insurance

Job description

By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claim Adjuster - General Liability and Product Liability | Jurisdiction: Mutli State | Licensing: Required - Hybrid
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world's best brands?
  • Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.

ARE YOU AN IDEAL CANDIDATE? To analyze mid- and higher-level general liability and product claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements.
WORK LOCATION: Hybrid to any Sedgwick Office Nation Wide
PRIMARY PURPOSE OF THE ROLE: We are looking for driven individuals that embody our caring counts model and core values that include empathy, accountability, collaboration, growth, and inclusion.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE
  • Manages mid-level general liability & product liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level.
  • Assesses liability and resolves claims within evaluation.
  • Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.
  • Manages subrogation of claims and negotiates settlements.
  • Communicates claim action with claimant and client.
  • Ensures claim files are properly documented and claims coding is correct.
  • May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
  • Maintains professional client relationships.

QUALIFICATIONS
Education and Licensing
Bachelor's degree from an accredited college or university preferred. Licenses as required. Professional certifications as applicable to line of business preferred.
Experience
Four (4) years of claims management experience or equivalent combination of education and experience required.
TAKING CARE OF YOU
Flexible work schedule.
Referral incentive program.
Career development and promotional growth opportunities.
A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is ($65,000.00 - $80,000.00 USD Annual). A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits. Always accepting applications.
#claimsexaminer #claims #hybrid #LI-REMOTE
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

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