ZipRecruiter

Log In

1

Insurance Claim Review Jobs (NOW HIRING)

twoharbors

Insurance Claim Specialist

Coppell, TX · On-site

Responsible for reviewing a pipeline of Insurance Claims to ensure a positive borrower experience while ensuring compliance with any agency and/or investor guidelines * Process Insurance Claim ...

Risk Strategies

Healthcare Lead Claims Specialist

$110K - $150K/yr

To provide ultimate claim service for insurance claim matters presented by clients of Risk ... Review claim trending and address any opportunities with the Client for Loss control initiatives.

CoAction

Claims Quality Audit Analyst

Morristown, NJ · On-site

... what insurance can be for our clients. The Claim Quality Audit Analyst, is responsible for overseeing claim quality reviews, calibration of manager reviews, compliance monitoring, and training ...

CoAction

Claims Quality Audit Analyst

Morristown, NJ · On-site

... what insurance can be for our clients. The Claim Quality Audit Analyst, is responsible for overseeing claim quality reviews, calibration of manager reviews, compliance monitoring, and training ...

Village Capital & Investment

VA Claim Processor

Hildale, UT · On-site

$13.75 - $17.50/hr

Review and process claims in accordance with VA guideline, ensuring that all information is ... Dental insurance * Health insurance * Health savings account * Life insurance * Paid time off

next page

Showing results 1-20

People also search for

All JobsInsurance Claim Review Jobs

Insurance Claim Review information

See salary details

$12

$23

$43

How much do insurance claim review jobs pay per hour?

As of May 28, 2026, the average hourly pay for insurance claim review in the United States is $23.50, according to ZipRecruiter salary data. Most workers in this role earn between $17.55 and $25.72 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Insurance Claim Review Specialist, and why are they important?

To thrive as an Insurance Claim Review Specialist, you typically need a strong understanding of insurance policies, claims processes, and relevant regulations, often backed by a degree in business, finance, or a related field. Familiarity with claims management software, document management systems, and sometimes certifications such as AIC (Associate in Claims) are commonly required. Attention to detail, analytical thinking, and effective communication are critical soft skills for evaluating claims and interacting with policyholders. These skills ensure accurate, timely, and fair claim resolutions that uphold company standards and customer satisfaction.

What are some common challenges faced in an Insurance Claim Review role, and how can they be managed effectively?

One of the most common challenges in Insurance Claim Review is managing a high volume of claims while maintaining accuracy and compliance with regulatory standards. Claims can often be complex, requiring careful analysis of policy terms, medical or incident documentation, and communications with policyholders or third parties. Effective time management, attention to detail, and strong communication skills are essential. Collaborating closely with other departments, such as underwriting and legal, can also help resolve ambiguous cases more efficiently. Ongoing training and keeping up with changes in industry regulations further support success in this role.

What is insurance claim review?

Insurance claim review is the process by which insurance companies evaluate claims submitted by policyholders to determine their validity and the extent of coverage. Claims reviewers carefully examine documentation, such as medical records, police reports, or repair estimates, to ensure all policy requirements are met. This process helps prevent fraud, ensures claims are paid accurately, and maintains the integrity of the insurance system. Claim reviewers may also communicate with claimants, request additional information, or work with other professionals to make informed decisions.

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

AspectInsurance Claim ReviewInsurance Adjuster
CredentialsTypically requires insurance or claims processing certificationsRequires licensing and adjuster certifications
Work EnvironmentOffice-based, reviewing claims remotely or on-siteFieldwork, inspecting damages, meeting clients
Employer & Industry UsageInsurance companies, third-party claims servicesInsurance companies, independent adjusting firms
Search & Comparison IntentUnderstanding claim review roles, job dutiesAssessing damage, settling claims

Insurance Claim Review professionals focus on evaluating and verifying insurance claims, often working in an office setting. Insurance Adjusters, on the other hand, inspect damages firsthand and negotiate settlements. Both roles require insurance-related certifications but differ in work environment and responsibilities.

More about Insurance Claim Review jobs
What cities are hiring for Insurance Claim Review jobs? Cities with the most Insurance Claim Review job openings:
What states have the most Insurance Claim Review jobs? States with the most job openings for Insurance Claim Review jobs include:
What job categories do people searching Insurance Claim Review jobs look for? The top searched job categories for Insurance Claim Review jobs are:
Insurance Claim Review jobs near you
Infographic showing various Insurance Claim Review job openings in the United States as of May 2026, with employment types broken down into 18% Full Time, 73% Part Time, and 9% Contract. Highlights an 25% Physical, 19% Hybrid, and 56% Remote job distribution, with an average salary of $48,885 per year, or $23.5 per hour.
Insurance Claim Specialist

Insurance Claim Specialist

Southern Ohio Medical Center

Portsmouth, OH • On-site

Full-time

Posted 28 days ago

Southern Ohio Medical Center rating

6.7

Company rating: 6.7 out of 10

Based on 38 frontline employees who took The Breakroom Quiz

599th of 989 rated hospitals

Job description

Current Employees: If you are currently employed at SOMC please log into UKG Pro to use the internal application process.
Department: Claims Management
Shift/schedule: Full Time (40 hrs/wk)
GENERAL SUMMARY
Works under the supervision of the Assistant Manager of Claims Management and Lead Insurance Claim Specialists. The Insurance Claim Specialist's primary job functions is to analyze, process, submit, and follow up on inpatient and outpatient medical claims. Is responsible for safeguarding the public relations and confidentiality of the organization and its records by consistent professional conduct.
QUALIFICATIONS
Education:
  • High School Diploma or successful completion of an equivalent High School Exam Required

Licensure:
  • None

Experience:
  • Three to six months of related work experience in medical billing preferred

JOB SPECIFIC DUTIES AND PERFORMANCE EXPECTATIONS
The following is a summary of the major job duties of this job. Other duties may be performed, both major and minor, which are not mentioned below. Specific activities may change from time to time.
  1. Reviews all claims for complete and accurate information.
  2. Contacts other SOMC departments, physician offices, and insurance companies to obtain necessary information to file complete, accurate, and timely claims.
  3. Processes, edits, and submits all claims for the organization.
  4. Follows up on Commercial, Worker's Comp, VA, and Governmental claims by phone calls to the insurance companies, websites, or any online resources available.
  5. Works with the patient/guarantor by phone to assist with any questions regarding unpaid claims. Obtains information from the patient/guarantor with which to submit the claim for payment (i.e., claim forms, Medicare Secondary Payer (MSP) Questionnaire, etc.)
  6. Processes administrative appeals, reinstatements, and rejections of insurance claims.
  7. Completes account follow up daily, maintaining established goals, and notifies the Lead Specialist, when necessary, of issues preventing achievement of such goals.
  8. Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues.
  9. Adheres to HIPPA regulations by verifying pertinent information to determine caller authorization level receiving information on account.
  10. Identifies billing and coding issues with individual claims, notifying medical billers for correction.
  11. Makes determinations through on-line systems of patient eligibility, coverage, and reviews status of claims.
  12. Performs other duties as assigned.

Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions of the position in accordance with applicable law. A full job description is available upon request.
Thank you for your interest in Southern Ohio Medical Center. Once you have applied, the most updated information on the status of your application can be found by visiting the candidate Home section of this site. Please view your submitted applications by logging in and reviewing your status
Southern Ohio Medical Center is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, ancestry, color, disability, ethnicity, gender identity, or expression, genetic information, military status, national origin, race, religion, sex, gender, sexual orientation, pregnancy, protected veteran status or any other basis under the law.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

What Southern Ohio Medical Center employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply