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Medical Insurance Reviewer Jobs (NOW HIRING)

The US Oncology Network

Insurance Reviewer

Eugene, OR · On-site

$22 - $32/hr

Reviews, processes and audits the medical necessity for treatments including radiation oncology ... Obtains insurance authorization and pre-certification for various oncology & hematology related ...

The US Oncology Network

Insurance Reviewer

Eugene, OR

$22 - $32/hr

Reviews, processes and audits the medical necessity for treatments including radiation oncology ... Obtains insurance authorization and pre-certification for various oncology & hematology related ...

Springfield Clinic

Insurance Reviewer II

Springfield, IL · On-site

$18.22 - $26.42/hr

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment ... Previous experience in a medical billing office required. Knowledge, Skills and Abilities Working ...

Springfield Clinic

Insurance Reviewer II

Springfield, IL · On-site

$18.22 - $26.42/hr

The Insurance Reviewer II is responsible for completing assigned tasks involved in securing payment ... Previous experience in a medical billing office required. Knowledge, Skills and Abilities Working ...

AppleOne

Medical Insurance Claims

Bakersfield, CA · On-site +1

$23/hr

Job Summary We are seeking a detail-oriented Medical Insurance Claims professional for a full-time ... In this role, you will review, process, audit, and resolve medical and facility claims for payment ...

Barry G Willens MD PA

Be Seen First

Medical Insurance Specialist

New Caney, TX · On-site

$17.36 - $20.68/hr

Review patient demographics and insurance information for accuracy * Document verification ... Previous medical insurance verification and referral experience required * Knowledge of commercial ...

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Medical Insurance Reviewer information

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$11

$42

$100

How much do medical insurance reviewer jobs pay per hour?

As of Jun 30, 2026, the average hourly pay for medical insurance reviewer in the United States is $42.06, according to ZipRecruiter salary data. Most workers in this role earn between $22.84 and $54.09 per hour, depending on experience, location, and employer.

What are some common challenges faced by Medical Insurance Reviewers when handling claim approvals?

Medical Insurance Reviewers often encounter challenges such as interpreting complex medical documentation, staying updated with evolving insurance policies, and ensuring compliance with regulatory requirements. Balancing the need for thorough analysis with the pressure of meeting turnaround times can also be demanding. Effective communication with healthcare providers and policyholders is key to resolving discrepancies and ensuring claims are processed accurately and efficiently.

What are the key skills and qualifications needed to thrive as a Medical Insurance Reviewer, and why are they important?

To thrive as a Medical Insurance Reviewer, you need a solid understanding of medical terminology, claims processing, and healthcare regulations, often supported by experience in healthcare administration or a related certification. Familiarity with claims management software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is typically required. Attention to detail, analytical thinking, and effective communication are essential soft skills for accurately evaluating claims and collaborating with healthcare providers. These skills ensure accurate claim assessments, compliance with regulations, and efficient processing, which are critical for minimizing errors and supporting the financial health of both insurers and patients.

What skills do you need to be a medical reviewer?

A medical reviewer needs strong knowledge of medical terminology, healthcare regulations, and insurance policies. Critical thinking, attention to detail, and good communication skills are essential for evaluating claims accurately. Familiarity with electronic health records (EHR) systems and relevant certifications, such as a nursing license or medical degree, can also be important.

How to become a medical claims examiner?

To become a medical claims examiner, typically one needs a high school diploma or equivalent, with many employers preferring postsecondary education or certification in health insurance or medical billing. Relevant skills include attention to detail, knowledge of insurance policies, and familiarity with medical coding systems like ICD or CPT. Gaining experience through entry-level claims processing roles can also be beneficial.

What does a Medical Insurance Reviewer do?

A Medical Insurance Reviewer is responsible for evaluating medical claims submitted by healthcare providers to ensure they meet policy guidelines and are medically necessary. They review patient records, treatment plans, and insurance policies to determine coverage eligibility and approve or deny claims accordingly. Their work helps prevent fraudulent or incorrect payments and supports both insurance companies and insured individuals in navigating the claims process.

What is an insurance reviewer?

A medical insurance reviewer evaluates insurance claims and medical documentation to determine coverage eligibility and payment amounts. They analyze medical records, verify policy details, and ensure compliance with insurance policies, often using specialized software and requiring knowledge of healthcare regulations.

How do you become a medical reviewer?

To become a medical reviewer, candidates typically need a medical degree such as an MD or DO, along with experience in healthcare or insurance. Additional certifications like a medical license and knowledge of medical coding or insurance policies can be beneficial. Strong analytical skills and attention to detail are essential for reviewing medical records and determining coverage eligibility.
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Medical Insurance Reviewer jobs near you
Infographic showing various Medical Insurance Reviewer job openings in the United States as of June 2026, with employment types broken down into 80% Full Time, and 20% Part Time. Highlights an 70% In-person, and 30% Remote job distribution, with an average salary of $87,476 per year, or $42.1 per hour.
Insurance Reviewer

Insurance Reviewer

The US Oncology Network

Eugene, OR • On-site

$22 - $32/hr

Full-time

Life, Retirement

Posted 25 days ago

US Oncology rating

7.5

Company rating: 7.5 out of 10

Based on 105 frontline employees who took The Breakroom Quiz

227th of 877 rated healthcare providers

Job description

Overview
Insurance Reviewer - Clinical
Willamette Valley Cancer Institute is looking for an Insurance Reviewer to support our patients receiving testing and treatment needed for their diagnosis by navigating insurance portals and obtaining all appropriate authorizations. With a focus on authorizations for infusion drugs, radiation therapy, imaging, genetics and surgeries our Insurance Reviewers pave the way for our patients and treatment team to follow the prescribed treatment pathway. An individual that thrives in a high-volume workspace, with the ability to manage shifting priorities will find success in this role.
The general pay scale for this position at WVCI is $22.00-$32.00. The actual hiring rate is dependent on many factors, including but not limited to: prior work experience, education, job/position responsibilities, location, work performance, internal equity, etc.
Employment Type: Full Time
Benefits: M/D/V, Life Ins., 401(k)
Location: Eugene, OR
Responsibilities
  • Reviews, processes and audits the medical necessity for treatments including radiation oncology, gynecologic surgery, genetic lab testing, imaging, and chemotherapy treatment for each patient. Documentation of regimen related to pathway adherence and payer guidelines.
  • Communicate with nursing, physician, pharmacists and medical staff to inform them of any restrictions or special requirements in accordance with particular insurance plans. Provides prompt feedback to physicians and management regarding pathway documentation issues, and payer issues with non-covered chemotherapy drugs.
  • Updates coding/payer guidelines for clinical staff. Tracks pathways and performs various other business office functions on an as needed basis
  • Obtains insurance authorization and pre-certification for various oncology & hematology related services.
  • Maintains a good working knowledge of chemotherapy authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization.
  • Adheres to confidentiality, state, federal, and HIPAA laws and guidelines with regards to patient's records.
  • Other duties as requested or assigned.

Qualifications
  • High school degree or equivalent.
  • Minimum three (3) years of prior authorization experience required. Revenue cycle experience preferred.

PHYSICAL DEMANDS:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is required to be present at the employee site during regularly scheduled business hours and regularly required to sit or stand and talk or hear. Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Occasionally lifts and carries items weighing up to 40 lbs. Requires corrected vision and hearing to normal range.
WORK ENVIORNMENT:
The work environment may include exposure to communicable diseases, toxic substances, ionizing radiation, medical preparations and other conditions common to an oncology/hematology clinic environment. Work will involve in-person interaction with co-workers and management and/or clients. Work may require minimal travel by automobile to office sites.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

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