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Medical Claim Reviewer Jobs in Indiana (NOW HIRING)

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Medical Claim Reviewer information

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.

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 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 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 popular job titles related to Medical Claim Reviewer jobs in Indiana?

For Medical Claim Reviewer jobs in Indiana, the most frequently searched job titles are:

What job categories do people searching Medical Claim Reviewer jobs in Indiana look for?

The top searched job categories for Medical Claim Reviewer jobs in Indiana are:

What cities in Indiana are hiring for Medical Claim Reviewer jobs?

Cities in Indiana with the most Medical Claim Reviewer job openings:

Medical Claim Reviewer jobs near you
Infographic showing various Medical Claim Reviewer job openings in Indiana as of August 2026, with employment types broken down into 90% Full Time, and 10% Part Time. Highlights an 90% In-person, 5% Hybrid, and 5% Remote job distribution.

Medical Director, Orthopedic Spine Surgery - Remote

Indianapolis, IN • On-site

Genoa Telepsychiatry
Offices of Mental Health Practitioners • 51 - 200 employees
Learn more about Genoa Telepsychiatryexternal

$248K - $373K/yr

Other

Retirement

Posted yesterday

New

Job description

Medical Director

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

As part of the Focus Claims Review team at Optum, the Medical Director provides leadership, organization, and direction for the claims review program. They are responsible for the overall quality, effectiveness and coordination of the medical services provided through Optum. The Medical Director will participate in all aspects of claim review services including provider telephonic discussions and provider appeals. In addition, the Medical Director may also be asked to assist in the direction and oversight in the development and implementation of policies and procedures and clinical criteria for all medical programs and services. The Medical Director will serve as a liaison between Optum, physicians, and other medical service providers in selected situations primarily related to medical claim reviews.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Reviews surgical and other professional claims for correct coding using clinical record
  • Participation in Training regarding URAC, NCQA, Regulatory Compliance, Confidentiality, Conflict of Interest, HIPAA, and department specific training as applicable
  • Discusses cases and clinical coding situations with treating providers telephonically during scheduled hours
  • Participates in periodic clinical conferences / calls and in ongoing internal performance consistency reviews
  • Composes, if needed, patient situation specific, clinical summaries and rationales for medical necessity decisions
  • Supports compliance with regulatory agency standards and requirements (e.g., CMS, NCQA, URAC, state / federal and third-party payers)
  • Provide Clinical support for staff that conduct initial reviews

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • MD or DO with a current, active, and fully unrestricted medical license
  • Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) in Orthopedic Surgery, with fellowship training and substantial clinical experience in Spine Surgery
  • 5+ years of clinical experience post residency
  • MS Office (MS Word, Excel, and Power Point)

Preferred Qualifications:

  • Experience working for a managed care organization
  • Experience with professional claim coding / claim coding reviews
  • Knowledge of claim coding resources and techniques
  • Proficient computer skills and ability to learn to use clinical and claims software
  • Proven excellent interpersonal skills and the ability to work over the telephone with other colleagues including physicians, nurses, PTs, OTs and other similar personnel

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500 - $373,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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