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Medical Insurance Reviewer Jobs in Ohio (NOW HIRING)

Unison Health

Fair Hearing - Medical Insurance

Toledo, OH

$29.25 - $38.75/hr

Medical with federal minimum deductibles * Dental and Vision coverage * Retirement planning and ... Ensure Notices of Action are issued and reviewed for compliance, including required timelines ...

ssollc

Onsite Reviewer - Ohio

Canton, OH · On-site

$25/hr

Onsite Reviewer - Ohio (5 Openings) Locations: * Columbus * Cleveland * Akron/Canton * Cincinnati ... Medical Insurance * Dental Insurance * Vision Insurance * 401(k) with Employer Match * Paid Time ...

Toledo Clinic

INSURANCE BILLER - FULL TIME

Toledo, OH · On-site

Review and follow up of unpaid claims. Works under the supervision of the Business Services ... Processes all insurance claims and correspondence. * Follows-up with companies ensuring claims are ...

VITAS Healthcare

Medical Records Reviewer

Moraine, OH · On-site

$14.75 - $17.75/hr

Life insurance * 401(k) plan with numerous investment options and generous company match * Cancer and/or critical illness benefit * Tuition Reimbursement * Paid Time Off * Employee Assistance Program

VITAS Healthcare

Medical Records Reviewer

Dublin, OH · On-site

$16 - $19/hr

Life insurance * 401(k) plan with numerous investment options and generous company match * Cancer and/or critical illness benefit * Tuition Reimbursement * Paid Time Off * Employee Assistance Program

VITAS Healthcare

Medical Records Reviewer

Cincinnati, OH · On-site

$16.25 - $19.50/hr

Benefits Include: - Competitive compensation - Health, dental, vision, life and disability insurance - Pre-tax healthcare and dependent care flexible spending accounts - Life insurance - 401(k) plan ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical ... insurance, wellness programs and financial education resources, to name a few. Elevance Health ...

VITAS Healthcare

Medical Records Reviewer

Dayton, OH · On-site

$16.50 - $19.75/hr

Life insurance * 401(k) plan with numerous investment options and generous company match * Cancer and/or critical illness benefit * Tuition Reimbursement * Paid Time Off * Employee Assistance Program

VITAS Healthcare

Medical Records Reviewer

Columbus, OH · On-site

$16 - $19/hr

Life insurance * 401(k) plan with numerous investment options and generous company match * Cancer and/or critical illness benefit * Tuition Reimbursement * Paid Time Off * Employee Assistance Program

VITAS Healthcare

Medical Records Reviewer

Cincinnati, OH · On-site

$16.25 - $19.50/hr

Life insurance * 401(k) plan with numerous investment options and generous company match * Cancer and/or critical illness benefit * Tuition Reimbursement * Paid Time Off * Employee Assistance Program

VITAS Healthcare

Medical Records Reviewer

Cincinnati, OH · On-site

$16.25 - $19.50/hr

Benefits Include: - Competitive compensation - Health, dental, vision, life and disability insurance - Pre-tax healthcare and dependent care flexible spending accounts - Life insurance - 401(k) plan ...

Elevance Health

Nurse Reviewer 1

Mason, OH

Conducts initial medical necessity clinical screening and determines if initial clinical ... insurance, wellness programs and financial education resources, to name a few. Elevance Health ...

Elevance Health

Nurse Reviewer 1

Mason, OH · On-site

Conducts initial medical necessity clinical screening and determines if initial clinical ... insurance, wellness programs and financial education resources, to name a few. Elevance Health ...

Belcan

MEDICAL BILLER

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 clearing house. * Monitor rejected claim reports and adjust claims for ...

New

Belcan

MEDICAL BILLER

Mason, OH

$22.55/hr

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

New

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All JobsMedical Insurance Reviewer JobsMedical Insurance Reviewer Jobs in Ohio

Medical Insurance Reviewer information

See Ohio salary details

$11

$39

$95

How much do medical insurance reviewer jobs pay per hour?

As of Aug 8, 2026, the average hourly pay for medical insurance reviewer in Ohio is $39.98, according to ZipRecruiter salary data. Most workers in this role earn between $21.73 and $51.44 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?

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 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 are popular job titles related to Medical Insurance Reviewer jobs in Ohio? For Medical Insurance Reviewer jobs in Ohio, the most frequently searched job titles are:
What job categories do people searching Medical Insurance Reviewer jobs in Ohio look for? The top searched job categories for Medical Insurance Reviewer jobs in Ohio are:
Medical Insurance Reviewer jobs near you
Infographic showing various Medical Insurance Reviewer job openings in Ohio as of August 2026, with employment types broken down into 87% Full Time, 7% Part Time, 3% Temporary, and 3% Contract. Highlights an 90% In-person, 3% Hybrid, and 7% Remote job distribution, with an average salary of $83,163 per year, or $40 per hour.

Fair Hearing - Medical Insurance

Unison Health

Toledo, OH • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 3 days ago

Job description

Why Join Unison Health?
Unison Health provides a mission-driven work environment focused on staff support, professional growth, and work-life balance. We are committed to helping our employees thrive while making a lasting difference in the lives of children and families. For over 50 years, Unison Health has proudly supported individuals, families, and communities across Ohio. From behavioral health and substance abuse treatment to primary healthcare, we are dedicated to our mission: Making Lives Better.
Compensation & Benefits:
  • Paid Time Off (PTO) Starting at 16 Days/Year
  • Medical with federal minimum deductibles
  • Dental and Vision coverage
  • Retirement planning and employer contribution
  • Apply to Hear More!

Position Summary:
Medicaid Appeals, Grievance & Fair Hearing Officer is a senior administrative and compliance role responsible for overseeing Medicaid grievances, appeals, and State Fair Hearing activities in compliance with 42 CFR Part 438. This position serves as the organization's primary subject matter expert on adverse benefit determinations, authorization denials, continuation of benefits, and Ohio Medicaid State Fair Hearing preparation and representation.
Key Responsibilities & Role Highlights:
  • Oversee and manage Medicaid grievances and appeals related to service denials, reductions, suspensions, terminations, and failure-to-act cases in accordance with regulatory requirements.
  • Ensure Notices of Action are issued and reviewed for compliance, including required timelines, content, appeal rights, and continuation of benefits provisions.
  • Coordinate with clinical, utilization management, billing, and provider teams to gather documentation and support appeal determinations.
  • Lead the preparation and coordination of Ohio Medicaid State Fair Hearings, including appeal summaries, hearing packets, and supporting documentation.
  • Represent or support the organization during hearings before the Ohio Department of Job and Family Services (ODJFS) Bureau of State Hearings.
  • Provide guidance and training to providers and staff regarding Medicaid appeals, grievances, hearing rights, and regulatory requirements.
  • Monitor, identify, and escalate compliance concerns, including potential issues related to denials, recoupments, and adverse benefit determinations.
  • Analyze grievance and appeal trends, prepare reports for leadership, and recommend quality improvement and risk mitigation strategies.

Education & Experience Requirements:
  • Bachelor's degree in health administration, Social Work, Public Administration, Legal Studies, or a related field required.
  • Experience managing Medicaid grievances, appeals, and/or State Fair Hearing processes required.
  • Working knowledge of Medicaid regulations, including 42 CFR Part 438.
  • Strong written and verbal communication skills, with the ability to prepare formal appeal summaries and case documentation.
  • Master's degree or advanced credential preferred (e.g., JD, RN, LISW-S, LPCC-S, or equivalent).
  • Experience representing or supporting cases in Ohio Medicaid State Fair Hearings preferred.
  • Knowledge of behavioral health, substance use disorder (SUD), and/or long-term services and supports (LTSS) preferred.
  • Strong organizational, analytical, and problem-solving skills with attention to detail and regulatory compliance.

Unison Health is an Equal Opportunity Employer (EOE).
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

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