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Medical Claim Review Jobs (NOW HIRING)

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 ...

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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 ...

US Tech Solutions

Medical Reviewer LPN #

Columbia, SC · On-site

$23/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 ...

divvyDOSE

SSBV Clinical Claim Review | , |

$28.94 - $51.83/hr

Ssbv Clinical Claims Review Rn Optum is a global organization that delivers care, aided by ... Medical Plan options along with participation in a Health Spending Account or a Health Saving ...

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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.
More about Medical Claim Review jobs
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Medical Claim Review jobs near you

Medical Claim Analyst

Secure Eclaims LLC

Miami, FL • On-site

Full-time

Posted 6 days ago

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Job description

  • 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 stay reviews to determine reasonable and necessary care, and appropriateness of stay. Recommends appropriate payments of dispute of billing, as necessary.
  • Provides second review of bills on which providers question the appropriateness of payments authorized.
  • Evaluates claims referred for medical management and makes recommendations for follow-up, further investigation or documentation as necessary.
  • Trains and assists claims staff on quality health care cost containment and utilization reviews.

Company Description

Leading specialty benefits management company in Puerto Rico and South Florida. Our innovative care management model integrates the needs of providers, payors and members to ensure the delivery of high quality, cost effective care while realizing substantial millions of dollars savings that keep the cost of healthcare down.
We are building a model for managing care delivery that embodies traditional values, promises reliability, and embraces flexibility and technology. Through our experience in the healthcare industry, the company aims to improve healthcare outcomes, achieve cost savings and serve as a single point of contact to move into value-based care.