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Medical Claims Reviewer Jobs (NOW HIRING)

Broadway Ventures

Medical Claims Reviewer (RN)

OR · Remote

This role involves conducting pre- and post-payment medical reviews to ensure compliance with ... Review medically complex claims , pre-authorization requests, appeals, and fraud/abuse referrals.

Searhc

Medical Claims Analyst

Juneau, AK

$31.83 - $44.56/hr

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

Robert Half

Medical Claims Representative

Springfield, MA · Remote

$18.21 - $21.09/hr

Review and process medical claims for accuracy, completeness, and eligibility * Investigate and resolve claim discrepancies, denials, and payment issues * Verify insurance coverage, benefits, and ...

Posted today

Next Step Systems

Medical Claims Coder

Tucson, AZ · On-site

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 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 ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

Provides support and review of medical claims and utilization practices. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC · On-site

Provides support and review of medical claims and utilization practices. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

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 ...

Oak St. Health

Pharmacy Technician - Claims Reviewer

$43K - $85K/yr

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 ...

Lorven Technologies

Physician ED Claims Reviewer

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.

New

CTC

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Medical Claims Coordinator

Mason, OH · On-site

$22.55/hr

Review medical claims and transmit to the insurance carrier using the practice electronic health records(EHR)system and clearinghouse. * Monitor rejected claim reports and adjust claims for ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

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 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 ...

Inceed

Medical Claims Specialist

Tulsa, OK · On-site

$18 - $20/hr

Medical Claims Specialist Compensation: $18 - $20 /hour, depending on experience Location: Tulsa ... Review claims-related processes for accuracy. * Support testing in the QNXT system. * Verify member ...

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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 7, 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 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.

Medical Claims Reviewer: Utilization & Coverage

001 BlueCross and BlueShield of South Carolina

Myrtle Beach, SC

Full-time

Medical, Retirement

Posted 17 days ago

Job description

001 BlueCross and BlueShield of South Carolina is seeking a qualified professional to conduct medical and utilization reviews. This role involves determining coverage, managing claims processes, and providing education to members and caregivers. Candidates should possess a Bachelor's degree in Social Work or relevant nursing qualifications, alongside a minimum of 2 years' clinical experience. Benefits include comprehensive health coverage, a 401(k) plan, and on-site amenities such as cafeterias and fitness centers. Join us in promoting health and wellness while upholding our commitment to quality service. #J-18808-Ljbffr

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