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Insurance Claim File Review Jobs in Texas (NOW HIRING)

Ccfs

Risk Claims Manager

Houston, TX · Remote

$85/hr

Review and determine coverages and work with insurance companies to set claim reserves. Identify ... Will lead claim file reviews as requested. Ensure the Company is taking appropriate measures to ...

BTI Solutions

Logistics Claim Operator

Plano, TX · On-site

Google Review 4.4, Facebook Review 4.8 Logistics Claim Operator Key Responsibilities Review new submissions to ensure all required documentation and claim details are included File and manage ...

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Insurance Claim File Review information

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

As of Jun 14, 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, and why are they important?

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.
Insurance Claim File Review jobs near you

TPA Performance Specialist, Liability Claims

AmTrust Financial Services, Inc.

Dallas, TX • On-site, Remote

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 15 days ago

Job description

Responsible for executing quality reviews on claims for Commercial Liability lines of coverage. Engages with claim leadership to discuss feedback and training with the various claim departments.  Partners with key stakeholders to improve compliance with claim quality standards and reduction of leakage. Acts as a trusted advisor for the business. Maintains a solid understanding of AmTrust’s mission, vision, and values. Upholds the standards of the AmTrust organization. 

This position will require hybrid attendance in an AmTrust location and is posted remotely for nationwide visibility. 


  • Conduct Claim File Audits:Regularly review claim files to ensure compliance with company standards and regulatory requirements. 
  • Provide Feedback:Offer constructive feedback on audit results and suggest improvements to enhance claim processing quality. 
  • Develop Quality Improvement Strategies:Assist in creating and implementing strategies to improve the overall quality of claims handling. 
  • Training and Support:Assist in providing training sessions to claims staff to improve their knowledge and skills. 
  • Analyze Data:Create and review reports on claim quality trends to identify areas of opportunity and make recommendations for process improvements. 
  • Customer Relations:Work with claim teams on corrective action plans 
  • Creates consumable reports and delivers assessment results to the appropriate level of leadership and applicable stakeholders. 
  • Analyzes and interprets data to monitor trends, identify root causes, and partners with the business to proactively isolate issues and support the development of measurable action plans. 
  • Prioritizes tasks effectively, meeting assessment/project due dates, and identifies and escalates competing demands and/or dependencies. 
  • Develops and maintains a strong understanding of QA methodologies, tools, and risk management principles. 
  • Keeps current with market trends and demands.  
  • Performs other duties as assigned. 

  • Bachelor’s Degree in related field OR equivalent business experience. 
  • 5+ years of related claims experience, with recent background in a quality or compliance oversight role. 
  • Strong oral and written communication skills. 
  • Ability to evaluate, prioritize and make informed decisions to ensure timely and accurate completion of all assignments. 
  • Applicable claims, compliance, risk, and/or legal designations such as ARM, AIC, CRCMP, CLMP, ARC, CPCU, SCLA, or IRES designations desirable.
  • Licensing:A valid adjuster license may be required, depending on the state and company regulations 

This role is essential for maintaining the integrity and efficiency of the claims process, ensuring that customers receive accurate and timely service. 

#LI-BL1


AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

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