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Medical Claim Review Jobs (NOW HIRING)

Larkin Community Hospital

Medical Claim Adjuster

Miami, FL · On-site

$63K - $81K/yr

Medical Claim Adjuster DEPARTMENT: Patient Accounts SUPERVISOR: Business Office Director Larkin ... Review and interpret contract language using provider contracts to confirm whether a claim is ...

Apply Early

Crawford and Company

Medical Claim Analyst

Metairie, LA · On-site

$14.88 - $27.22/hr

Medical Claim Analyst This is an exciting opportunity to join a global leader in claims management ... Reviews and updates data into a computerized system. * Approves payments of medical bills on lost ...

CEI

Medical Reviewer (LPN) - Remote

Columbia, SC

$22.25 - $30.25/hr

May provide any of the following in support of medical claims review and utilization review practices: * Performs medical claim reviews and makes a reasonable charge payment determination. * Monitors ...

CEI

LPN/Medical Reviewer - Remote

Columbia, SC · Remote

$22.25 - $30.25/hr

May provide any of the following in support of medical claims review and utilization review practices: * Performs medical claim reviews and makes a reasonable charge payment determination. Monitors ...

Crawford and Company

Medical Claim Analyst

Metairie, LA · Hybrid

$3.5K/mo

Medical Claim Analyst This is an exciting opportunity to join a global leader in claims management ... Reviews and updates data into a computerized system. * Approves payments of medical bills on lost ...

US Tech Solutions

Medical Reviewer LPN #

May provide any of the following in support of medical claims review and utilization review practices: * Performs medical claim reviews and makes a reasonable charge payment determination. * Monitors ...

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 ...

OSI Vision

Medical Claims Reviewer

San Antonio, TX · On-site

Perform medical claim review activities in support of Security Assistance and Security Cooperation training programs. * Receive, track, and verify medical, dental, and pharmacy pre-authorizations and ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors ...

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Medical Claim Review information

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How much do medical claim review jobs pay per hour?

As of Jul 2, 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, and why are they important?

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 does a claims reviewer do?

A claims reviewer evaluates insurance claims to determine their validity and ensure they comply with policy guidelines. They review medical documentation, verify coverage, and decide whether to approve, deny, or request additional information, often using specialized software and adhering to industry regulations.

What jobs make $3,000 a day?

High-paying jobs that can earn $3,000 a day include specialized medical roles such as senior surgeons, anesthesiologists, and certain medical directors, often requiring advanced certifications and extensive experience. Other professions like top-tier corporate executives, successful entrepreneurs, and high-level legal or financial consultants may also reach this income level, typically through a combination of skill, reputation, and workload. These roles often involve demanding schedules and significant responsibility.

How to become a medical claims examiner?

To become a medical claims examiner, individuals typically need a high school diploma or equivalent, with some positions requiring postsecondary education or certification in health insurance or medical billing. Relevant skills include attention to detail, knowledge of medical terminology, and familiarity with insurance policies and claims processing software. Certification programs such as the Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects.

What skills do you need to be a medical reviewer?

A medical reviewer needs strong knowledge of medical terminology, healthcare regulations, and insurance policies. Critical thinking, attention to detail, and good communication skills are essential for accurately assessing claims. Familiarity with electronic health records and relevant certifications, such as a nursing license or medical degree, can also be beneficial.

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.
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Medical Claim Review jobs near you
Medical Claim Adjuster

Medical Claim Adjuster

Larkin Community Hospital

Miami, FL • On-site

$63K - $81K/yr

Full-time

Posted 10 days ago

Be an early applicant

Job description

JOB TITLE: Medical Claim Adjuster

DEPARTMENT: Patient Accounts

SUPERVISOR: Business Office Director

Larkin Health System is an integrated healthcare delivery system accredited by the Joint Commission with locations in South Miami, Hialeah and Hollywood, Florida. Our network of acute care hospitals provide a complete continuum of healthcare services, including a full range of inpatient and outpatient services, and home health agencies in Miami-Dade and Broward County. We are heavily invested in training the next generation of health professionals, which is the core of our mission: to provide access to compassionate care of the highest quality in an educational environment.

GENERAL JOB DESCRIPTION

Under the direction of the Business Office Director, the Medical Claim Adjuster is responsible for reviewing and adjusting accounts in accordance with claims processing guidelines.

DUTIES AND RESPONSIBILITIES

  • Perform adjustments using technical and claims processing expertise.
  • Identify discrepancies in payments, adjust accounts based on expected amount.
  • Review and interpret contract language using provider contracts to confirm whether a claim is overpaid or underpaid.
  • Review denials and ensures posting reflects the appropriate denial reason code.
  • Review and handle relevant correspondences assigned to the team that may result in adjustments to accounts.
  • Preforms related duties as required.

QUALIFICATIONS FOR THE JOB

Education:

High School diploma of equivalent (additional certifications or education in medical billing/coding preferred)

Experience:

  • 1-2+ year’s claims processing experience.

Other:

  • Strong understanding of medical terminology, CPT codes, ICD-10 codes, and insurance billing guidelines.
  • Excellent numerical and analytical skills, with a keen eye to detail.
  • Ability to interpret insurance EOBs and payment information accurately.
  • Strong problem-solving skills, with the ability to reconcile discrepancies and resolve payment-related issues effectively.
Larkin Community Hospital logo

About Larkin Community Hospital

Sourced by ZipRecruiter

At Larkin, we have been serving the health care needs of South Miami, Hialeah, and the surrounding communities for more than 40 years. We take pride in the continuing tradition of caring. We remain dedicated to providing excellent medical care with the personal touch and convenience that only a community hospital offers.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

South Miami, FL, US

Year founded

1969

Social media

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