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Medical Claims Reviewer Jobs (NOW HIRING)

Searhc

Medical Claims Analyst

Juneau, AK

$31.83 - $44.56/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This role performs claims review and processing, eligibility verification, referral validation ... Performs all duties of the Medical Claims Specialist role, including review, screening, eligibility ...

Next Step Systems

Medical Claims Coder

Tucson, AZ · On-site

  • Medical

  • Retirement

  • PTO

Medical Claims Coder, Tucson, AZ Under general supervision from the Director of Operations, the ... Review and resolve rejected and/or denied claims. Conduct research and analysis of claims ...

Next Step Systems

Medical Claims Coder

Tucson, AZ · On-site

  • Medical

  • Retirement

  • PTO

Medical Claims Coder, Tucson, AZ The Medical Claims Coder needs experience with ICD-10, Current ... Review and resolve rejected and/or denied claims. Conduct research and analysis of claims ...

Community Medical Group

Medical Claims Specialist

Miami, FL · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Review medical and pharmacy claims, eligibility files, and clinical documentation to identify contestation opportunities * Develop, maintain, and improve contestation policies and procedures

Oak St. Health

Pharmacy Technician - Claims Reviewer

$43K - $85K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

The Claims Reviewer is responsible for reviewing pharmacy claims submitted through the CVS Health ... We offer a comprehensive benefits package which includes medical, dental, vision insurance as well ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

  • Medical

  • Retirement

  • PTO

Medical Claims Examiner Responsibilities: - Submit claims and encounters in a timely manner. - Review and resolve rejected, pended, and/or denied claims within expected timeframes. - Coordinate claim ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

  • Medical

  • Retirement

  • PTO

Medical Claims Examiner, Tucson, AZ Under general supervision from the Director of Operations, the ... Review and resolve rejected and/or denied claims. Conduct research and analysis of claims ...

Kintegra Health

Medical Claims Supervisor

Gastonia, NC · On-site

  • Medical

  • Vision

... Review claim status, member eligibility, benefit coverage, provider contract terms, coding ... to medical claims processing. · Monitor key performance indicators (KPIs), claims inventory ...

New

AVA Consulting

Medical Claims Coordinator/Processor

Mason, OH · On-site

$17 - $22.50/hr

Review open/unpaid claim balances and take required action. Major Duties & Responsibilities: * Review medical claims and transmit to the insurance carrier using the practice electronic health records ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

  • Medical

  • Retirement

  • PTO

Medical Claims Examiner, Tucson, AZ The Medical Claims Examiner needs experience with ICD-10, ... Review and resolve rejected and/or denied claims. Conduct research and analysis of claims ...

Robert Half

Medical Claims Analyst

Cleveland, OH · On-site

$27 - $35/hr

Review Medicaid-related claims activity and analyze billing information to support timely and ... medical claims, medical billing, or Medicaid-focused revenue cycle work. * Strong hands-on ...

Datamark, Inc.

Medical Claims Processor

El Paso, TX

$16.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

Privia Health

Medical Claims Billing Specialist

Houston, TX · On-site

$24/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... claims, reviewing and responding to daily correspondence from physician practices in a timely ... The Medical Claims Specialist will take steps necessary to resolve all claim issues or questions ...

Datamark, Inc.

Medical Claims Processor

El Paso, TX · On-site

$16.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Team as a Medical Claims Processor! Are you looking for an exciting opportunity where your ... Pull and review customer accounts to assess eligibility, benefits, and coverage limitations

Adecco

Medical Claims Examiner

San Antonio, TX

$22.50/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... review, verify, and accurately process claims Previous claims department experience preferred Core Responsibilities Review and adjudicate medical claims for accuracy and compliance Ensure timely and ...

Vytwo

Physician ED Claims Reviewer

Prosper, TX · On-site

$201K - $239K/yr

Physician with an active US licensed with experience in with medical coding (CPT/HCPCS) and managed care to conduct clinical review of claims and UM authorization requests for clinical necessity.

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Medical Claims Reviewer information

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How much do medical claims reviewer jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for medical claims reviewer in the United States is $20.88, according to ZipRecruiter salary data. Most workers in this role earn between $17.79 and $23.08 per hour, depending on experience, location, and employer.

What are some common challenges faced by medical claims reviewers and how can they be managed effectively?

Medical Claims Reviewers often encounter challenges such as interpreting complex medical documentation, ensuring compliance with ever-changing healthcare regulations, and managing tight deadlines. Staying current with policy updates and medical coding changes is essential for accuracy. Effective time management, attention to detail, and ongoing training can help reviewers handle workloads efficiently while minimizing errors. Collaborating with colleagues in billing, coding, and clinical teams also aids in resolving discrepancies and ensuring claims are processed correctly.

What is a medical claims reviewer?

Medical claims reviewers are professionals who evaluate health insurance claims to determine their accuracy, validity, and compliance with policy guidelines. They review medical records, billing codes, and documentation to ensure that services billed by healthcare providers are medically necessary and covered by the patient's insurance plan. Their work helps prevent fraud, reduce errors, and ensure that insurance companies only pay for appropriate medical expenses. Medical claims reviewers play a crucial role in the healthcare reimbursement process, working for insurance companies, third-party administrators, or healthcare providers.

What are the key skills and qualifications needed to thrive as a medical claims reviewer, and why are they important?

To thrive as a Medical Claims Reviewer, you need a solid understanding of medical terminology, coding systems (such as ICD-10 and CPT), and insurance policies, often supported by a background in healthcare administration or medical billing. Familiarity with claims processing software, electronic health records (EHR), and sometimes certification as a Certified Professional Coder (CPC) is valuable. Attention to detail, analytical thinking, and strong written communication help reviewers accurately assess claims and document findings. These skills ensure precise claim evaluations, minimize errors, and support fair, timely reimbursement decisions.

What is the difference between Medical Claims Reviewer vs Medical Billing Specialist?

AspectMedical Claims ReviewerMedical Billing Specialist
CredentialsTypically requires insurance or healthcare certifications, such as CPC or CCSOften requires billing or coding certifications, like CPC or CPC-A
Work EnvironmentHealthcare insurance companies, third-party administrators, or healthcare providersMedical offices, hospitals, or billing companies
Job FocusReviewing and validating insurance claims for accuracy and compliancePreparing and submitting medical bills to insurance companies and patients

The Medical Claims Reviewer and Medical Billing Specialist roles share overlapping skills in healthcare documentation and insurance processes. However, the Claims Reviewer primarily focuses on evaluating and validating claims for accuracy, while the Billing Specialist handles the creation and submission of bills. Both roles are essential in the healthcare revenue cycle and often work closely within healthcare organizations.

More about Medical Claims Reviewer jobs
What states have the most Medical Claims Reviewer jobs? States with the most job openings for Medical Claims Reviewer jobs include:
What job categories do people searching Medical Claims Reviewer jobs look for? The top searched job categories for Medical Claims Reviewer jobs are:
Medical Claims Reviewer jobs near you
Infographic showing various Medical Claims Reviewer job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.

Medical Claims Analyst

Southeast Alaska Regional Health Consortium

Juneau, AK • On-site

$31.83 - $44.56/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 21 days ago

Southeast Alaska Regional Health Consortium rating

8.0

Company rating: 8.0 out of 10

Based on 10 frontline employees who took The Breakroom Quiz

Job description

Pay Range:
Pay Range:$31.83 - $44.56The Medical Claims Analyst is responsible for supporting the accuracy, completeness, and compliance of medical claims processing and related Purchased/Referred Care (PRC) activities across the organization. This role performs claims review and processing, eligibility verification, referral validation, payment research, system administration, workflow support, and data integrity monitoring to ensure authorized services are processed accurately and timely. The position partners with PRC leadership, Finance, providers, internal departments, and external vendors to resolve complex claims issues, support reporting needs, improve claims processing workflows, and strengthen operational performance. Additionally, the role supports training, special projects, system upgrades, audit preparation, policy updates, and process improvement initiatives that advance PRC program compliance, provider communication, and financial decision-making.
SEARHC is a non-profit health consortium which serves the health interests of the residents of Southeast Alaska. We see our employees as our strongest assets. It is our priority to further their development and our organization by aiding in their professional advancement.
Working at SEARHC is more than a job, it's a fulfilling career. We offer generous benefits, including retirement, paid time off, paid parental leave, health insurance, dental, and vision benefits, life insurance and long and short-term disability, and more.
Key Essential Functions and Accountabilities of the Job
  • Performs all duties of the Medical Claims Specialist role, including review, screening, eligibility verification, alternate health resource verification, referral validation, claim processing, claims research, customer service, and interpretation of PRC Program regulations, policies, and procedures for internal and external customers.
  • Serves as the system administrator for the PRC claims processing platform, including user access coordination, system configuration support, workflow maintenance, issue tracking, testing, troubleshooting, and coordination with internal departments and external vendors as needed.
  • Maintains data integrity within the claims processing system by monitoring claim data, validating system outputs, supporting timely correction of errors, and identifying opportunities to improve accuracy, efficiency, and consistency in claims processing workflows.
  • Develops and supports training for providers, PRC staff, internal departments, and other key stakeholders on claims submission requirements, claims status processes, system workflows, documentation expectations, and applicable PRC policies and procedures.
  • Supports reporting projects for finance leadership and the executive team by gathering, validating, analyzing, and summarizing claims data, utilization trends, outstanding liabilities, denial activity, payment status, and other information needed for operational, financial, and strategic decision-making.
  • Partners with PRC leadership, Finance, providers, and other stakeholders to resolve complex claims issues, improve claims processing workflows, support provider communication, and ensure accurate and timely payment of authorized services.
  • Assists with special projects, process improvement initiatives, system upgrades, audit support, policy updates, and other duties as assigned.

Additional Job Description
Education, Certifications, and Licenses Required
  • High school diploma or equivalent required.
  • Medical terminology course required or 1 year of documented experience in a medical field requiring consistent use of medical terminology.
  • Bachelors degree in health care administration, business, finance, information systems, or related field preferred.

Experience Required
  • 2 years of data entry experience with basic knowledge of accounts payable processing, MS Excel, and MS Word software applications.
  • 4 years of business, medical office, claims processing, revenue cycle, health care finance, or related experience OR an equivalent combination of education and experience.
  • Experience processing medical claims in a tribal health organization preferred.
  • Experience with claims processing systems, system administration, reporting, training, workflow support, or process improvement preferred.
  • Medical coding background preferred.

Knowledge of
  • State, federal, and tribal health care programs.
  • Medical insurance process.
  • PRC Program regulations, policies, and procedures.
  • ICD, CPT, revenue, and diagnosis coding.
  • Claims processing systems, data entry standards, workflow controls, and system integrity practices.
  • Basic reporting concepts, data validation, and financial or operational analysis.

Skills in
  • Interpreting state, federal, and tribal contract health care guidelines.
  • Research, problem solving, claims analysis, and issue resolution.
  • Using claims processing systems, MS Excel, MS Word, and related reporting tools.
  • Training, presenting information, and communicating technical or process information to providers, staff, and other stakeholders.
  • Oral/written interpersonal communication and excellent customer service skills.

Ability to
  • Ability to multitask and manage competing priorities.
  • Ability to enter, review, and analyze large volumes of data timely and accurately.
  • Ability to work independently with minimal supervision and exercise sound judgment in resolving claims and system-related issues.
  • Ability to support users, troubleshoot workflow issues, and coordinate system-related follow-up with internal and external stakeholders.
  • Ability to prepare clear, accurate, and timely reporting to support finance leadership and executive decision-making.
  • Ability to respond quickly in urgent situations with attention to detail.

Required Certifications:
If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

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