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Medical Claim Reviewer Jobs (NOW HIRING)

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 ...

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 ...

FCCI Insurance Group

Medical Claim Adjuster

Glen Allen, VA · Hybrid

$22.54 - $34.72/hr

Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury. * Document claim activity, maintain claim files, and establish appropriate reserves. * Process ...

FCCI Insurance Group

Medical Claim Adjuster

Sarasota, FL · On-site

$22.54 - $34.72/hr

Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury. * Document claim activity, maintain claim files, and establish appropriate reserves. * Process ...

FCCI Insurance Group

Medical Claim Adjuster

Sarasota, FL · Hybrid

$22.54 - $34.72/hr

Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury. * Document claim activity, maintain claim files, and establish appropriate reserves. * Process ...

FCCI Insurance Group

Medical Claim Adjuster

Lake Mary, FL · Hybrid

$22.54 - $34.72/hr

Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury. * Document claim activity, maintain claim files, and establish appropriate reserves. * Process ...

FCCI Insurance Group

Medical Claim Adjuster

Ridgeland, MS · Hybrid

$22.54 - $34.72/hr

Review medical documentation and monitor treatment to ensure ongoing care is related to the work injury. * Document claim activity, maintain claim files, and establish appropriate reserves. * Process ...

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 ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

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

PGBA, LLC

Reviewer I, Medical

Myrtle Beach, SC · On-site

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

PGBA

Reviewer I, Medical

Myrtle Beach, SC · On-site

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

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

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

CEI

LPN/Medical Reviewer - Remote

Columbia, SC · Remote

$22.25 - $30.25/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 ...

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 ...

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 ...

Home Care Delivered

Revenue Claim Reviewer I

Glen Allen, VA · On-site

$76K - $77K/yr

HCD provides only the highest quality medical supplies and products. We carry thousands of items ... Must demonstrate experience in Microsoft office and proficiency in claim management systems.

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Medical Claim Reviewer information

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$5

$16

$18

How much do medical claim reviewer jobs pay per hour?

As of Jul 13, 2026, the average hourly pay for medical claim reviewer 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 the difference between Medical Claim Reviewer vs Medical Claims Processor?

AspectMedical Claim ReviewerMedical Claims Processor
Required CredentialsHigh school diploma or equivalent; certifications like CPC or CCS beneficialHigh school diploma or equivalent; certifications less common
Work EnvironmentInsurance companies, healthcare providers, third-party administratorsInsurance companies, healthcare facilities, billing departments
Job FocusReviewing and verifying claims for accuracy and complianceProcessing and entering claims data into systems
Common Search IntentUnderstanding roles, responsibilities, and qualificationsLearning about claims processing tasks and requirements

The main difference is that Medical Claim Reviewers focus on evaluating and verifying claims for accuracy and compliance, while Medical Claims Processors handle the data entry and initial processing of claims. Both roles are essential in the claims management process and often work closely within insurance and healthcare organizations.

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 a degree in health administration or related field. Familiarity with claims management software, coding systems like ICD-10 and CPT, and regulatory compliance is typically required. Attention to detail, analytical thinking, and strong communication skills set top performers apart in this position. These skills are crucial to accurately evaluating claims, ensuring regulatory compliance, and minimizing errors or fraud in healthcare billing.

What are some common challenges faced by Medical Claim Reviewers, and how can they be managed?

Medical Claim Reviewers often face challenges such as interpreting complex medical records, keeping up with frequent changes to insurance policies, and managing high volumes of claims within tight deadlines. Effective time management, ongoing training, and strong communication skills are key to overcoming these obstacles. Collaborating closely with healthcare providers and insurance representatives also helps ensure accurate claim assessments and fosters a smoother workflow.

What does a Medical Claim Reviewer do?

A Medical Claim Reviewer is responsible for evaluating medical insurance claims to determine their accuracy, completeness, and compliance with policy guidelines. They review the documentation submitted by healthcare providers and patients, verify medical codes, and ensure that the treatments or services billed are medically necessary and covered by the insurance plan. Their work helps prevent fraudulent claims and ensures that insurance payments are processed fairly and correctly.
More about Medical Claim Reviewer jobs
What cities are hiring for Medical Claim Reviewer jobs? Cities with the most Medical Claim Reviewer job openings:
Who are the top companies hiring for Medical Claim Reviewer jobs? The top employers for Medical Claim Reviewer jobs are:
What states have the most Medical Claim Reviewer jobs? States with the most job openings for Medical Claim Reviewer jobs include:
What job categories do people searching Medical Claim Reviewer jobs look for? The top searched job categories for Medical Claim Reviewer jobs are:
Medical Claim Reviewer jobs near you
Infographic showing various Medical Claim Reviewer job openings in the United States as of July 2026, with employment types broken down into 81% Full Time, 16% Part Time, 1% Temporary, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $35,000 per year, or $16.8 per hour.
Medical Claim Reviewer (CGS, DMEC-B)

Medical Claim Reviewer (CGS, DMEC-B)

Broadway Ventures

Remote

Full-time

Re-posted 15 days ago

Job description

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation.
Max Salary: W-2 ($65,000/$31.25)
Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
About the Role
We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
Key Responsibilities
  • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
  • Assess payment determinations using clinical information and established guidelines.
  • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
  • Provide clear, well-documented rationales for service approvals or denials.
  • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
  • Support quality control activities to meet corporate and team objectives.
  • Provide guidance to LPN team members and support non-clinical staff through training and discussions.
  • Assist with special projects and additional responsibilities as assigned.
Minimum Qualifications
Licensure:
  • Active, unrestricted RN license in the U.S. and in the state of hire
    OR
  • Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
  • Associate Degree in Nursing
    OR
  • Graduate of an accredited School of Nursing.
Experience:
  • Two years of clinical experience.
Skills & Competencies:
  • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
  • Ability to interpret and apply medical review criteria and clinical guidelines.
  • Proficiency in Microsoft Office and word processing software.
  • Strong analytical, organizational, and decision-making skills.
  • Ability to work independently while managing priorities effectively.
  • Excellent customer service, communication, and critical thinking skills.
  • Ability to handle confidential information with discretion.

What to Expect Next:
After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.
Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.
Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

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