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Medical Claims Reviewer Jobs (NOW HIRING)

TEEMA

Claims Reviewer

Phoenix, AZ · Remote

$25 - $29/hr

Conducts medical claims review using current claims processing guidelines and established clinical criteria e.g. CDST and policy keys, to evaluate medical necessity, appropriateness of care and ...

TEEMA

Claims Reviewer

Phoenix, AZ · Remote

$26.40 - $27.88/hr

If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you! Position Highlights * Role : Conduct retrospective review of medical, surgical, and ...

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 ...

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 ...

Searhc

Medical Claims Specialist

Juneau, AK · On-site

$25 - $28.45/hr

Review and screen all medical and dental claims from PRC health care providers. This requires verifying that the patient on claim is in our system using Cerner. * Performs alternate health resource ...

Ourhrconnect

Reviewer I, Medical

Myrtle Beach, SC

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

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Medical Claims Reviewer information

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How much do medical claims reviewer jobs pay per hour?

As of Jul 26, 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 are medical claims reviewers?

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 July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $43,428 per year, or $20.9 per hour.
Claims Reviewer

Claims Reviewer

TEEMA

Phoenix, AZ • Remote

$25 - $29/hr

Full-time

Posted 24 days ago

Job description


Job Tittle: Claims Reviewer
Job ID: 75861
Location: Arizona - Remote
What you will be doing:

  • Conducts medical claims review using current claims processing guidelines and established clinical criteria e.g. CDST and policy keys, to evaluate medical necessity, appropriateness of care and program benefits, exclusions and limitations.

  • Validates medical determinations through research of resources including regulatory manuals, computer files, and documentation.

  • Prepares cases program payment or medical director review as indicated.

  • Validates all appropriate data is supplied with program invoice.

  • Reviews claim data for process improvements related to all aspects of claims payment.

  • Ensures contract compliance for timelines regarding resolution of medical claims.

  • Communicates effectively with management and peers.

  • Consistently meets medical claims processing quotas.

  • Identifies and reports any potential quality or fraud issues to management, Quality Management, or Program Integrity as needed.

  • Provides support regarding clinical and coding questions.

  • Performs other duties as assigned.

  • Regular and reliable attendance is required.


What you must have:

  • High School Diploma or GED

  • 2+ years of claims review experience

  • Knowledge of all types of Medical claims review


Nice to have:

  • Claim coding experience

  • Knowledge of behavioral health claims review


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About Teema

Sourced by ZipRecruiter

TEEMA is an award-winning, industry-leading recruitment agency dedicated to building meaningful relationships across North America. We achieve this time after time by consistently sourcing, screening, managing and securing top talent tailored to employers’ specific needs. The team that makes this happen consists of hundreds of experienced professional recruiters backed by exceptional, tenured leadership and back-office support. No matter how unique or challenging your hiring needs may be or how misunderstood or undervalued your in-demand skills may be in your current role, we have you covered. Our primary objective is to provide an exceptional recruitment experience for our clients and candidates and an ecosystem that empowers our team to thrive.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Litchfield Park, AZ, US

Social media

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