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Medical Claim Reviewer Jobs in Raleigh, NC (NOW HIRING)

IFG Companies

Claim Assistant

Chapel Hill, NC · On-site

$50K - $52K/yr

Reviewing and handling of incoming and outgoing mail by identifying claim number and adjuster ... IFG Companies offers competitive compensation and benefits, currently including medical, dental ...

IFG Companies

Claim Examiner

Chapel Hill, NC · On-site

$80K - $100K/yr

Prompt reviewing of new losses and determining initial plans of action. * Analyzing coverage as it ... IFG Companies offers competitive compensation and benefits, currently including medical, dental ...

Robert Half

Medical Insurance Claims Specialist

Durham, NC · On-site

$20 - $23/hr

We are looking for a Medical Insurance Claims Specialist to join a growing revenue cycle team in ... Review and address claim issues by interpreting payer requirements, identifying coverage or billing ...

Veradigm

RCM Medical Billing Coordinator

Raleigh, NC · On-site

$19.50 - $25.25/hr

Reviews source codes; tallies Hash totals. * Maps ICD nine, CPT, and modifiers as needed. * Creates ... Work claim rejections for clients not with IHS and oversee the claim rejections worked by IHS for ...

Veradigm

RCM Medical Billing Coordinator

Raleigh, NC · On-site

$19.50 - $25.25/hr

Reviews source codes; tallies Hash totals. * Maps ICD nine, CPT, and modifiers as needed. * Creates ... Work claim rejections for clients not with IHS and oversee the claim rejections worked by IHS for ...

Atlantic Medical Management

RCM Coder

Cary, NC · Remote

$17.25 - $23.25/hr

... medical charges intoNextGensoftware in a timely manner to meet daily and monthly goals. * Reviews ... Work with providers to correct the diagnosis or procedure codes so that the claim can be processed.

NeighborHealth Center

Medical Billing Manager

Raleigh, NC · On-site

$47K - $62K/yr

... and review the transmission of claims in EPIC as well as other electronic and paper claim ... Required Knowledge, Experience, or Licensure/Registration 1. Associate's degree in medical billing ...

DAN

Claims Coordinator

Durham, NC · Hybrid

Common duties include reviewing claim forms, verifying information, contacting members and ... Serve as a liaison between DAN Medical Services, DAN Claims, and third-party assistance companies ...

DAN

Claims Coordinator

Durham, NC · On-site

$50K - $55K/yr

Common duties include reviewing claim forms, verifying information, contacting members and ... Medical Services, DAN Claims, and third-party assistance companies for emergent cases and ...

Deloitte

Epic Denials Management Operator

Raleigh, NC · Remote

$17.50 - $23.25/hr

Review hospital account records and payer remittance records, communicate with relevant Client RCM ... Experience analyzing billing workflows, claim issues, or operational data For individuals assigned ...

AMM Healthcare

RCM Coder

Cary, NC · Remote

$17.25 - $23.25/hr

... medical charges intoNextGensoftware in a timely manner to meet daily and monthly goals. * Reviews ... Work with providers to correct the diagnosis or procedure codes so that the claim can be processed.

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All JobsMedical Claim Reviewer JobsMedical Claim Reviewer Jobs in Raleigh, NC

Medical Claim Reviewer information

See Raleigh, NC salary details

$5

$16

$18

How much do medical claim reviewer jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for medical claim reviewer in Raleigh, NC is $16.36, according to ZipRecruiter salary data. Most workers in this role earn between $14.95 and $17.74 per hour, depending on experience, location, and employer.

How to be a medical claim reviewer?

To become a medical claim reviewer, typically one needs a background in healthcare, insurance, or related fields, along with knowledge of medical coding and billing. Many employers prefer candidates with certifications such as the Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS). Strong attention to detail, analytical skills, and familiarity with claims processing software are also important for success in this role.

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?

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.
What are popular job titles related to Medical Claim Reviewer jobs in Raleigh, NC? For Medical Claim Reviewer jobs in Raleigh, NC, the most frequently searched job titles are:
What job categories do people searching Medical Claim Reviewer jobs in Raleigh, NC look for? The top searched job categories for Medical Claim Reviewer jobs in Raleigh, NC are:
What cities near Raleigh, NC are hiring for Medical Claim Reviewer jobs? Cities near Raleigh, NC with the most Medical Claim Reviewer job openings:
Medical Claim Reviewer jobs near you
Infographic showing various Medical Claim Reviewer job openings in Raleigh, NC as of August 2026, with employment types broken down into 96% Full Time, and 4% Part Time. Highlights an 58% In-person, 19% Hybrid, and 23% Remote job distribution, with an average salary of $34,022 per year, or $16.4 per hour.

Property & Casualty Field Adj

North Carolina League of Municipalities

Raleigh, NC • On-site

$82K - $129K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 19 days ago

Job description


The North Carolina League of Municipalities (NCLM) is seeking a Property and Casualty Field Adjuster. This position is part of the Property and Casualty Claims team and the purpose of this position is to handle and adjust property and liability claims for members of the Insurance Trust. This is accomplished by investigating and evaluating primarily first/third party automobile claims along with a variation of other assigned claims involving other lines of business. Negotiating settlement with members, claimants, or their legal representative, and providing additional services as needed or requested by our member customers. Other duties include overseeing claims recovery, subrogation investigation and recovery, attending workshops, participating as a member of League committees, performing any additional duties assigned including attending annual conference.

Additional duties include:

  • Conducts investigations by contacting members and/or claimant; determining involved department and appropriate contact person; investigating claims; obtaining recorded or written statements; determining whether or not the claim should be settled or denied; identifying possible fraud; and providing direction for those who require assistance of expert.
  • Responsible for reporting, coverage and liability determinations, negotiations, and resolutions by determining the extent of the damages regarding a claim or loss and reporting to supervisor any claim problems; negotiating with members or claimants or their legal representative; maintaining a proper reserve; ensuring settlement documents are produced once settlement is obtained; and issuing settlement checks.
  • Professional development is achieved by attending continuing education courses and seminars; participating in industry-based insurance course work in pursuit of a professional designation; researching and reviewing publications, media reports; providing customer service; maintaining open communication; traveling to member locations; reviewing multiple coverage forms; performing additional functions when necessary.
  • Files documentation by inputting all file notes into the claims systems; attaching all documents to file in digital form; scanning documents for review by adjuster; and maintaining an active claim diary to ensure proper follow up with members and claimants.
  • Evaluates damages by investigating the loss or claim; determining the extent of the damage and calculating amount of depreciation; maintaining all claim reserves on each file; ensuring that the reserves are sufficient to reflect the exposure for each claim; and consulting with member prior to the formal denial or acceptance.
  • Oversees coverage analysis by determining the nature of the claim; reviewing forms and policies; and consulting with liability supervisor and underwriting.
  • Oversees subrogation and salvage by identifying subrogation potential; presenting documentation to substantiate our subrogation claim; coordinating with the regional auction company to pick up salvage to transport to the auction; obtaining title and power of attorney; preparing DMV notification; and filing notification with NC DMV as required by law.

NCLM offers best in class benefits to include employer paid medical, dental, vision and life insurance. 401k plan with employer match, employer paid parking and paid time off, access to an onsite fitness center and so much more!