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Medical Claim Review Jobs (NOW HIRING)

CVS Health

Medical Claim Analyst

$18.50 - $38.82/hr

Position Summary CCR is responsible for post - service claim review to determine if specific ... Medical Directors as required. -Review provider and member claims to determine if they meet CCR ...

UnitedHealthcare

Clinical Claim Review | , |

Review medical and administrative records for audit/compliance review * Travel to provider sites up to 25%/month to collect records and engage with providers * Present and participate in discussions ...

Integrated Resources

Care Review Clinician

Spokane, WA · On-site

To provide clinical expertise in the application of medical and reimbursement policies within the claim adjudication process through claim review, medical record review and research. To provide ...

LHH US

Medical Data Entry

Phoenix, AZ

$18 - $20/hr

Validate claim information and supporting documentation for accuracy, completeness, and consistency. * Review medical records, itemized bills, and related documentation to ensure all required ...

LHH US

Medical Data Entry

Phoenix, AZ · On-site

$18 - $20/hr

Validate claim information and supporting documentation for accuracy, completeness, and consistency. * Review medical records, itemized bills, and related documentation to ensure all required ...

The Reny Company

Medical Claim Processor

Plano, TX · On-site

$18.50 - $21/hr

THIS IS NOT A REMOTE POSITION The Reny Company's medical claim processor is a professional who ... The processor will work methodically as front-end support for our bill review department to ensure ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

Secure Eclaims LLC

Medical Claim Analyst

Miami, FL · On-site

* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...

Secure Eclaims LLC

Medical Claim Analyst

Miami, FL

* Reviews all medical/surgical billings for reasonable and necessary charges. Examines coding of operative reports, procedures, and multiple and complicated surgeries. * Performs hospital length of ...

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Medical Claim Review information

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$5

$16

$18

How much do medical claim review jobs pay per hour?

As of Sep 1, 2026, the average hourly pay for medical claim review in the United States is $16.83, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $18.27 per hour, depending on experience, location, and employer.

What is medical claim review?

Medical claim review is the process of evaluating healthcare insurance claims to ensure that the services billed are medically necessary, appropriately documented, and in compliance with policy guidelines. Reviewers assess the submitted claims for accuracy, completeness, and potential fraud, and determine whether the insurance company should approve or deny payment. This process helps control costs and ensures that patients receive appropriate care according to their insurance coverage.

What are the key skills and qualifications needed to thrive as a medical claim reviewer?

To thrive as a Medical Claim Reviewer, you need a solid understanding of medical terminology, insurance policies, and claims processing, often supported by experience in healthcare administration or a related certification such as Certified Professional Coder (CPC). Familiarity with claims management software, ICD-10/CPT coding systems, and electronic health records is typically required. Attention to detail, analytical thinking, and strong communication skills help ensure accuracy and clarity when reviewing and adjudicating claims. These skills are vital for minimizing errors, ensuring compliance, and facilitating efficient claim resolution in a fast-paced environment.

What are some common challenges faced in a medical claim review role, and how can they be addressed?

Professionals in Medical Claim Review often encounter challenges such as interpreting complex medical documentation, ensuring compliance with evolving insurance policies, and managing tight deadlines. Staying current with medical coding standards and payer guidelines is crucial to minimize errors and rejections. Effective communication with healthcare providers and insurance companies also helps resolve discrepancies quickly. Utilizing up-to-date claim management software and participating in ongoing training can help streamline workflows and ensure accuracy.

How to become a medical claim review?

To become a medical claim reviewer, candidates typically need a background in healthcare, such as a nursing or medical billing certification, along with knowledge of insurance policies and coding systems like ICD or CPT. Relevant skills include attention to detail, analytical thinking, and familiarity with claims processing software. Some positions may require a bachelor's degree or specific certifications, and on-the-job training is often provided.
More about Medical Claim Review jobs

What states have the most Medical Claim Review jobs?

States with the most job openings for Medical Claim Review jobs include:

Medical Claim Review jobs near you
Infographic showing various Medical Claim Review job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $35,000 per year, or $16.8 per hour.

Medical Claim Analyst

Remote

CVS Health
Health Care and Social Assistance • 10K+ employees

5.8

Company rating: 5.8 out of 10

Based on 4,359 frontline employees who took The Breakroom Quiz

92nd of 113 rated pharmacies

Recommended by students

Recommended by parents

Respectful managers

Learn more about CVS Healthexternal

$18.50 - $38.82/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

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

Job description

We're building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary
CCR is responsible for post - service claim review to determine if specific
services can be reimbursed to providers and members.
- The analyst role is integral to the CCR team.
-They start the CCR process with the claim submission to CCR with a complete
review of the claim and claim history. They compile all system information,
claim history, plan information, and any additional research into template as
required by the workflow and any legal and regulatory requirements for a
clinician review.
-They also collaborate with Medical Directors as required.
-Review provider and member claims to determine if they meet CCR review requirements.
-Follow applicable workflows, templates, and legal and compliance
requirements to provide a complete picture of what is requiring review to the CCR clinicians and medical directors.
-Organizes and prioritizes work to help meet regulatory and CCR claim turnaround times. Determines coverage, verifies eligibility, benefits, identifies discrepancies and applies all Medical Claim Management policies and procedures to assist in ensuring claims are handled per policy and legal requirements.
-Works with all appropriate internal and external departments and personnel to accurately review specified claims and/or clarify any issues found in the course of the review.
-Required to work in multiple systems including EWM, ASD, ATV, MedCompass and HRP.
-Other systems dependent on specific reviews criteria.
-Maintains and utilizes all resource materials and systems to effectively manage job responsibilities
Adheres to company policies to protect member
confidentiality.
Required Qualifications
2+ years experience and demonstrated ability to handle multiple assignments competently, accurately and efficiently.
Preferred Qualifications
Knowledge of utilization management rules and regulations and claim processing guidelines.
Claims Processing/ customer service experience preferred


Education Verifiable High School Diploma or GED.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$18.50 - $38.82

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This fulltime position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial wellbeing of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.


Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/25/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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