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Medical Claim Review Jobs (NOW HIRING)

US Tech Solutions

Licensed Practical Nurse #

Columbia, SC · On-site

$23/hr

Performs medical claim reviews and makes a reasonable charge payment determination. * Monitors process's timeliness in accordance with contractor standards. * Performs authorization process, ensuring ...

New

Pae

Senior Paralegal

Washington, DC · On-site

Works on special projects as assigned, focusing on claim review and coordination. Examples include tracking claims in conjunction with the Medical Expert team, assisting in the tracking of NIOSH ...

Robert Half

Medical Claims Representative

Chicago, IL · On-site

$22.80 - $26.40/hr

This role focuses on reviewing medical claim information, coordinating billing-related activities, and helping ensure accurate insurance processing across the claims lifecycle. The ideal candidate is ...

Pae

Senior Paralegal

Washington, DC · On-site

Works on special projects as assigned, focusing on claim review and coordination. Examples include tracking claims in conjunction with the Medical Expert team, assisting in the tracking of NIOSH ...

Wallace and Graham, PA

Claim Reviewer

Salisbury, NC · Remote

$19.25 - $24.25/hr

This person would be responsible for reviewing medical documentation and exposure records against claim filing criteria to determine if claimant has a compensable disease and a qualifying exposure ...

Reqroute, Inc

Be Seen First

Medical Billing Specialist

Boise, ID · On-site

$29/hr

Review CMS-1500 (Professional Claim Forms) and UB-04 (Institutional Claim Forms) for completeness and accuracy. * Verify claim information, identify missing documentation, and contact medical ...

New

Robert Half

Medical Claims Representative

Pleasanton, CA · On-site

$31.35 - $36.30/hr

We are looking for a Medical Claims Representative to join our team in Pleasanton, California in a ... The person in this role will support accurate claim review and member-related processing while ...

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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 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
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
Licensed Practical Nurse #

Licensed Practical Nurse #

US Tech Solutions

Columbia, SC • On-site

$23/hr

Other

Medical

Posted 2 days ago

Job description

$23 per hour

Columbia, SC

Contract

Job Description:

  • Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals.

  • Documents decisions using indicated protocol sets or clinical guidelines.

  • Provides support and review of medical claims and utilization practices.

  • 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 process's timeliness in accordance with contractor standards.

  • Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determination.

  • Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process.

  • May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made.

  • Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations.

  • Participates in quality control activities in support of the corporate and team-based objectives. Participates in all required training.

Experience:

  • 2 years clinical experience.

Skills:

  • Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills.

  • Ability to handle confidential or sensitive information with discretion.

  • Ability to remain in a stationary position and operate a computer. Required Software and Tools: Microsoft Office.

Education:

  • Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing.

Note:

  • 8:30am-5pm contract only - no end date provided.

  • Onsite 1-2 weeks, then will work remote, will provide the equipment will be required to come onsite as needed for meetings and training.

  • Must be a local candidate typical day will be reviewing clinical for pre-certifications for durable medical equipment, home health care and elective procedures.

  • Must have more than 2 years of nursing experience.

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com (http://www.ustechsolutionsinc.com) .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity,

national origin, disability, or status as a protected veteran.

AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.

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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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