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Insurance Claim File Review Jobs (NOW HIRING)

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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 15, 2026, the average hourly pay for insurance claim file review in the United States is $21.86, according to ZipRecruiter salary data. Most workers in this role earn between $17.07 and $25.72 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.
What states have the most Insurance Claim File Review jobs? States with the most job openings for Insurance Claim File Review jobs include:
Catastrophe Field Claims Specialist

Catastrophe Field Claims Specialist

AAA Auto Club Group

Monroe, MI

$67K - $80K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 19 days ago


AAA The Auto Club Group rating

7.5

Company rating: 7.5 out of 10

Based on 273 frontline employees who took The Breakroom Quiz

196th of 261 rated insurance


Job description

It's a great time to join AAA The Auto Club Group!

JOIN THE TEAM COMMITTED TO DRIVING YOUR CAREER FORWARD

Job Type:

Full time

Exempt/Non Exempt:

Salary

Job Description:


This catastrophe field claims specialist will cover territories in Detroit Michigan, Chicago Illinois, or Minneapolis Minnesota. Eligible candidates must live within commutable areas of these locations for consideration.

Catastrophe Field Claims Specialist - The AAA Auto-Club Group

Reports to: Claim Manager as appropriate

What you will do:

Work under minimal supervision with a high-level approval authority to handle complex technical issues and complex claims.

Claim handling responsibilities will include the following: reviewing assigned claims, contacting the insured and other affected parties, setting expectations for the remainder of the claim process, and initiating documentation in the claim handling system. Complete complex coverage analysis. Ensure all possible policyholder benefits are identified. Create additional sub-claims if needed. Complete an investigation of the facts regarding the claim to further and in more detail determine if the claim should be paid, the applicable limits or exclusions and possible recovery potential. Conduct thorough reviews of damages and determine the applicability of state law and other factors related to the claim. Evaluate the financial value of the loss. Approve payments for the appropriate parties accordingly. Refer claims to other company units when necessary (e.g., Underwriting, Recovery Units or Claims Special Investigation Unit). Thoroughly document and/or code the claim file and complete all claim closure and related activities in the assigned claims management system. Utilize strong negotiating skills.

Employees assigned to Auto Physical Damage ("APD") claim unit will handle complex claims involving settling Total Losses, inspecting vehicles and preparing estimates of damage. If in the DRS Examiner role, manage Direct Repair Shops for compliance with our program. Additional responsibilities may include the following: determining cause of damage, establishing liability, and identifying subrogation potential. Monitor repairs and approve car rental expense. Oversee APD Litigation cases. Manage the litigation process including attorney and budget management, participation in mediation activities and determining the appropriate settlement position. May assist Claim Manager with file reviews and training.

Claim Specialists assigned to Homeowner/CAT claim unit handle claims valued over $25,000 (for the inside desk role) and over $100,000 (for field role). Investigate claims requiring in-depth coverage analysis. When handling claims in the field, must prepare damage estimates using claims software. Review estimates for accuracy.May monitor contractor repair status. May assist Claim Manager with file reviews and training.

Supervisory Responsibilities:

None

How you will benefit:

  • A competitive yearly salary between $67,000 - $80,000

  • ACG offers excellent and comprehensive benefits packages, including:

  • Medical, dental and vision benefits

  • 401k Match

  • Paid parental leave and adoption assistance

  • Paid Time Off (PTO), company paid holidays, CEO days, and floating holidays

  • Paid volunteer day annually

  • Tuition assistance program, professional certification reimbursement program and other professional development opportunities

  • AAA Membership

  • Discounts, perks, and rewards and much more!

II. Required Qualifications:

Education:

  • Complete ACG Claim Representative Training Program or demonstrate equivalent knowledge or experience

  • In states where an Adjuster's license is required, the candidate must be eligible to acquire a State Adjuster's license within 90 days of hire and maintain as specified for appropriate states.

  • Must have a valid State Driver's License

Experience:

  • Three years of experience or equivalent training in the following:

  • negotiation of claim settlements

  • securing and evaluating evidence

  • preparing manual and electronic estimates

  • subrogation claims

  • resolving coverage questions

  • taking statements

  • establishing clear evaluation and resolution plans for claims

Knowledge and Skills:

Advanced knowledge of:

  • Advanced knowledge of:

  • Essential Insurance Act (Michigan)

  • Fair Trade Practices Act as it relates to claims

  • subrogation procedures and processes

  • intercompany arbitration

  • handling simple litigation

  • advanced knowledge of building construction and repair techniques

Ability to:

  • handle claims to the line Claim Handling Standards

  • follow and apply ACG Claim policies, procedures and guidelines

  • work within assigned ACG Claim systems including basic PC software

  • perform basic claim file review and investigations

  • demonstrate effective communication skills (verbal and written)

  • demonstrate customer service skills by building and maintaining relationships with insureds/claimants while exhibiting understanding of their problems and responding to questions and concerns

  • analyze and solve problems while demonstrating sound decision making skills

  • prioritize claim related functions

  • process time sensitive data and information from multiple sources

  • manage time, organize and plan work load and responsibilities

  • safely operate a motor vehicle in order to visit repair facilities, homes (for inspections), patients, etc.

  • research analyze and interpret subrogation laws in various states

  • travel outside of assigned territory which may involve overnight stay

  • relocate, work evenings or weekends

III. Preferred Qualifications

Education:

  • Associate degree in Business Administration, Insurance or a related field or the equivalent in related work experience

  • Completion of the Insurance Institute of America's: General Insurance Program, Associate in Claims, Associate in Management or equivalent

  • CPCU coursework or designation

  • Xactware Training

  • 1-2 years of full cycle homeowners claims handling experience

  • Experience handling personal property and additional living expense claims

  • Experience with internal water loss, fire, and smoke claims

Ability to:

  • Walk on roofs

  • Climb ladders

  • Lift up to 25 pounds

Work EnvironmentThis position is currently able to work remotely from a home office location for day-to-day operations, with traveling to field locations as necessary to complete job responsibilities, unless occasional team building activities is specified by leadership. This is subject to change based on amendments and/or modifications to the ACG Flex Work policy.

Who We Are

Become a part of something bigger.

The Auto Club Group (ACG) provides membership, travel, insurance, and financial service offerings to approximately 14+ million members and customers across 14 states and 2 U.S. territories through AAA, Meemic, and Fremont brands. ACG belongs to the national AAA federation and is the second largest AAA club in North America.

By continuing to invest in more advanced technology, pursuing innovative products, and hiring a highly skilled workforce, AAA continues to build upon its heritage of providing quality service and helping our members enjoy life's journey through insurance, travel, financial services, and roadside assistance.

And when you join our team, one of the first things you'll notice is that same, whole-hearted, enthusiastic advocacy for each other.

We have positions available for every walk of life! AAA prides itself on creating an inclusive and welcoming environment of diverse backgrounds, experiences, and viewpoints, realizing our differences make us stronger.

To learn more about AAA The Auto Club Group visit www.aaa.com

Important Note:

ACG's Compensation philosophy is to provide a market-competitive structure of fair, equitable and performance-based pay to attract and retain excellent talent that will enable ACG to meet its short and long-term goals. ACG utilizes a geographic pay differential as part of the base salary compensation program. Pay ranges outlined in this posting are based on the various ranges within the geographic areas which ACG operates. Salary at time of offer is determined based on these and other factors as associated with the job and job level.

The above statements describe the principal and essential functions, but not all functions that may be inherent in the job. This job requires the ability to perform duties contained in the job description for this position, including, but not limited to, the above requirements. Reasonable accommodations will be made for otherwise qualified applicants, as needed, to enable them to fulfill these requirements.

The Auto Club Group, and all its affiliated companies, is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, disability or protected veteran status.

Regular and reliable attendance is essential for the function of this job.

AAA The Auto Club Group is committed to providing a safe workplace. Every applicant offered employment within The Auto Club Group will be required to consent to a background and drug screen based on the requirements of the position.


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American Automobile Association logo

About American Automobile Association

Sourced by ZipRecruiter

The American Automobile Association (AAA), headquartered in Heathrow, Florida, USA, is a reputable force in the automotive and insurance industry. Originating in 1902, it began as a coalition of motor clubs with the common goal of providing better roads and travel conditions for motorists. Today, AAA is a comprehensive, multifaceted organization that offers a range of services, including roadside assistance, auto repair services, travel agency services, and diverse insurance products - Auto, Home, Life and more. A significant principle for AAA is to continuously deliver value to their 61 million members through safety, security and peace of mind. The company's mission and core values focus on championing its members' rights and interests, advocating innovation, integrity, teamwork and respect.

Industry

Non-profits

Company size

10,000+ Employees

Headquarters location

Heathrow, FL, US

Year founded

1902

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