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Medical Claims Reviewer Jobs (NOW HIRING)

Redirect Health

Medical Claims Specialist

Phoenix, AZ · On-site

$20.75/hr

Own: Making sure medical claims are reviewed and processed accurately, so members aren't left waiting or wondering what happens next * Support: Members and providers by answering questions and ...

NTT Data Americas, Inc.

Medical Claims Processor

$17 - $18/hr

Reviewing the policies and benefits • Comply with company regulations regarding HIPAA ... s) of Medical Claims experience * 2+ year(s) using a computer with Windows applications that ...

Vanguard Group Staffing

Be Seen First

Medical Claims Processor

White Plains, NY · On-site

$24 - $30/hr

Long Term Temporary, Possible Temporary- to -Direct Hire Medical Billing/Claims Coordinator ... Review claims to determine if appropriate action was taken; follow up with Claims and Recovery ...

Trident

Medical Claims Examiner

$30/hr

Review, analyze, and process complex self-funded medical claims from start to finish. * Utilize the WLT system daily to adjudicate claims, ensuring all coding, billing, and pricing rules are applied ...

Moda Health

Medical Claims COB Processor I

Milwaukie, OR · Remote

$18.39 - $20.58/hr

Medical, Dental, Vision, Pharmacy, Life, & Disability * 401K- Matching * FSA * Employee Assistance ... Review, analyze, and resolve claims through the utilization of available resources for complex ...

Valenz

Certified Medical Claims Auditor

Phoenix, AZ · Remote

As a Certified Medical Claims Auditor (Clinical Bill Review Analyst), you'll review claims upfront ... Review medical bills to identify appropriate billing, coding, and savings opportunities. * Analyze ...

Karna, LLC

$20 - $25/hr

Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. * Critical Analysis:

KARNA LLC

$22 - $25/hr

Claims Review and Processing: Analyze and process a variety of complex medical claims in accordance with program policies and procedures, ensuring accuracy and compliance. * Critical Analysis:

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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 Analyst - Contract

krg technology inc

Scottsdale, AZ

Contractor

Re-posted 11 days ago

Job description

Job Description

Job Title : Medical Claims Analyst

Location : Scottsdale, AZ

Hiring Mode : Contract

Job Description

Review the scanned paper claims document and extracted information in an OCR application to ensure that there is no missing or incomplete information

Review couple of claims systems to identify the missing information and accurately capture the data/information necessary for processing

Correct the data elements extracted in OCR Application for self-learning where needed

Validate the claims that fall out while pre-load batch job into adjudication system, correct and re-load.

Additional Information

All your information will be kept confidential according to EEO guidelines.

KRG Technologies logo

About KRG Technologies

Sourced by ZipRecruiter

KRG Technologies was founded with a simple motive of offering the clients exactly what they want, how they want and when they want. By leveraging for its clients its technological edge and right-sourcing advantage, KRG in a short period of time has grown to become one of the most trusted strategic technology partners. Treating every client as the top priority, we customize our solutions and services to align with the unique needs of each client. Headquartered in Valencia, California, KRG employs a unique global delivery platform to minister its offerings spanning from application development and maintenance to business process reengineering. With years of hands-on domain experience and international presence, we offer state-of-the-art solutions backed by our follow-the-sun service model in the most cost effective manner. We value our clientele for the trust reposed in us and our clientele admire us for our personalized approach and deep commitment to their success. Our biggest strength lies in technical expertise of our team and individual competency of our employees, which enables us to be the most befitting solution provider.

Industry

It services

Company size

201 - 500 Employees

Headquarters location

Valencia, CA, US

Year founded

2003

Social media

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