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Medical Claim Reviewer Jobs in Reston, VA (NOW HIRING)

Peraton

Nurse Reviewer - Medicaid

Reston, VA · On-site

$66K - $106K/yr

The Medical Reviewer requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on ...

Peraton

Nurse Reviewer - Medicaid

Herndon, VA · On-site

$66K - $106K/yr

The Medical Reviewer requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on ...

C-MCI

Medical Billing Specialist

Fairfax, VA · On-site +1

$18.50 - $24/hr

... and minimal claim rejections. Why Join CMCI? * Opportunityto work with cutting-edge AI-driven ... Accuratelyprocess, review, and submit medical claims. * Verify CPT,ICD-10, and HCPCS codes to ...

Peraton

Medical Review Nurse- Medicare

Herndon, VA · On-site

$66K - $106K/yr

... Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment ...

New

Peraton

Medical Review Nurse- Medicare

Reston, VA · On-site

$66K - $106K/yr

... Reviewer to our SGS team of talented professionals. What you'll do: The position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment ...

New

Pae

ParalegaI

Washington, DC

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

Pae

Paralegal

Washington, DC

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

Pae

Paralegal

Washington, DC

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

Amentum

ParalegaI

Washington, DC · On-site

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

Amentum

Paralegal

Washington, DC · On-site

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

Pae

Paralegal

Washington, DC

$25.58/hr

Compiles and prepares supporting documentation for use by claim review attorneys in discovery ... medical conditions related to pregnancy, childbirth, or breastfeeding), age, ancestry, United ...

GI Alliance

Pharmacy Medical Secretary (31765)

Woodbridge, VA · On-site

$18.75 - $22.75/hr

Compounds: payment collection, claim creation, ecw documentation, and order placement through ... Daily unposted payment review * Tracking daily inventory counts of all drugs * Updating reporting ...

Amentum

Paralegal

Washington, DC · On-site

Responding to questions from claim reviewers about consult status on tracker. * Prepares Basic/Private Physician/Extraordinary Circumstance/Medical Expense and other packets as required including ...

Pae

Paralegal

Washington, DC

Responding to questions from claim reviewers about consult status on tracker. * Prepares Basic/Private Physician/Extraordinary Circumstance/Medical Expense and other packets as required including ...

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Medical Claim Reviewer information

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How much do medical claim reviewer jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for medical claim reviewer in Reston, VA is $17.51, according to ZipRecruiter salary data. Most workers in this role earn between $16.01 and $18.99 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 Reston, VA?

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

What job categories do people searching Medical Claim Reviewer jobs in Reston, VA look for?

The top searched job categories for Medical Claim Reviewer jobs in Reston, VA are:

What cities near Reston, VA are hiring for Medical Claim Reviewer jobs?

Cities near Reston, VA with the most Medical Claim Reviewer job openings:

Medical Claim Reviewer jobs near you

Nurse Reviewer - Medicaid

Peraton

Reston, VA • On-site

$66K - $106K/yr

Other

Posted 11 days ago

Peraton rating

8.3

Company rating: 8.3 out of 10

Based on 56 frontline employees who took The Breakroom Quiz

50th of 223 rated it services

Job description


Nurse Reviewer - Medicaid
Job Locations
US
Requisition ID
2026-169510
Position Category
Business Controls
Clearance
No Clearance Required
Responsibilities

SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse.

We are looking to add a Medical Reviewer to our SGS team of talented professionals.

What you'll do:

The Medical Reviewer requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions.

Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, over payment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support.

Roles and Responsibilities:

    Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government
  • Research regulations and cite violations.
  • Conduct self-directed research to uncover problems in Medicaid payments made to institutional and non-institutional providers.
  • Make claim payment decisions based on clinical knowledge
  • This position may require the incumbent to appear in court to testify about work findings.
  • Ability to compose correspondence, reports, and referral summary letters.
  • Ability to communicate effectively, internally and externally.
  • Ability to handle confidential material.
  • Ability to report work activity on a timely basis.
  • Ability to work independently and as a member of a team to deliver high quality work.
  • Ability to attend meetings, trainings, and conferences as needed. Overnight travel may be required.
  • Telework available from contiguous United States.

Qualifications

Basic Qualifications:

  • Bachelors and 5 years of experience, Masters degree and 3 years of experience, Associates and 7 years of experience
  • At least 3 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity.
  • Current/Active Nursing or Physical Therapy license in state of residence.
  • Strong investigative skills
  • Strong communication and organization skills
  • Strong PC knowledge and skills
  • U.S. citizenship required

Desirable Qualifications:

  • Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases
  • Knowledge of Medicaid requirements, laws, rules and regulations related to payment for services billed
  • Have a CPC (Certified Professional Coder) certificate.

Peraton Overview

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world's leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can't be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we're keeping people around the world safe and secure.

Target Salary Range
$66,000 - $106,000. This represents the typical salary range for this position. Salary is determined by various factors, including but not limited to, the scope and responsibilities of the position, the individual's experience, education, knowledge, skills, and competencies, as well as geographic location and business and contract considerations. Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay.
EEO
EEO: Equal opportunity employer, including disability and protected veterans, or other characteristics protected by law.

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About Peraton

Sourced by ZipRecruiter

At Peraton, we re at the forefront of delivering the next big thing every day. We re the partner of choice to help solve some of the world s most daunting challenges, delivering bold, new solutions to keep people around the world safer and more secure.

Industry

It services

Company size

10,000+ Employees

Headquarters location

Herndon, VA, US

Year founded

2017

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