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Medical Insurance Reviewer Jobs (NOW HIRING)

Community Health Network

Medical Reviewer

Medical Reviewer Community Health Network of Connecticut, Inc. (CHNCT) is currently seeking a ... Group term life insurance * A 401(k) plan with company-match and immediate vesting * Voluntary ...

OSI Vision

Medical Claims Reviewer

San Antonio, TX · On-site

We are seeking Medical Claims Reviewers to assist the Air Force Security Assistance and Training ... Working knowledge of medical terminology, insurance terminology, agencies policies, practices and ...

OSI Vision

Medical Claims Reviewer

Randolph, TX · On-site

Air Force insurance processes. This is a detail-oriented, mission-critical position. You will be ... Review medical, dental, and pharmacy claims for International Military Students (IMS) and their ...

OSI VISION LLC

Air Force insurance processes. This is a detail-oriented, mission-critical position. You will be ... Review medical, dental, and pharmacy claims for International Military Students (IMS) and their ...

OSI VISION LLC

Medical Claims Reviewer

Randolph, TX · On-site

Air Force insurance processes. This is a detail-oriented, mission-critical position. You will be ... Review medical, dental, and pharmacy claims for International Military Students (IMS) and their ...

HOPCo

Insurance Follow Up/ Medical Biller

Phoenix, AZ · On-site

Minimum two to three years of experience in medical billing. * Must be able to communicate ... Reviews insurance denials and rejections to determine the next appropriate action steps and obtain ...

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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.
Prior Authorization Specialist/Clinical Insurance Reviewer (Remote - Southern Nevada only)

Prior Authorization Specialist/Clinical Insurance Reviewer (Remote - Southern Nevada only)

The US Oncology Network

Henderson, NV • On-site

$16.75 - $22.50/hr

Full-time

Posted 26 days ago

Key responsibilities

  • Reviews, processes, and audits the medical necessity for patient radiation oncology treatment, imaging, and testing requests.

  • Obtains insurance authorization and pre-certification for imaging, pulmonology, and surgical services, and serves as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.

  • Researches denied services and alternative resources for non-covered chemotherapy services to prevent payment denials and provides contact lists for community resources.

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
At Comprehensive Cancer Centers of Nevada (CCCN) a distinguished team of doctors, researchers, nurses and healthcare professionals have provided patients with groundbreaking treatments on the healing edge of medicine for over 50 years. Our team is dedicated to providing the most effective treatments, both existing and emerging, in order to diagnose and successfully treat cancer and blood disorders. We support this goal with state-of-the-art facilities across Southern Nevada, all of which integrate the latest diagnostic, therapeutic and research capabilities. CCCN is dedicated to patient-centered care, advancing innovation, discovery, and improving outcomes. Motivated, caring professional are encouraged to join us.
Career Opportunity:
Comprehensive Cancer Centers of Nevada is seeking a Clinical Insurance Reviewer to work remotely in the Southern Nevada area only. The Clinical Reviewer reviews diagnostic imaging and pulmonary testing orders in accordance to reimbursement guidelines and obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments.
Scope:
Under general supervision, reviews chemotherapy regimens in accordance to reimbursement guidelines. Obtains necessary pre-certifications and exceptions to ensure no delay in reimbursement of treatments. Researches denied services and alternative resources to pay for treatment. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
Responsibilities
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Reviews, processes and audits the medical necessity for each patient radiation oncology treatment, imaging and testing requests
  • Communicates with nursing 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 documentation issues and payer issues with non-covered or denied services
  • Updates coding/payer guidelines for clinical staff
  • Obtains insurance authorization and pre-certification for imaging, pulmonology and surgical services; works as a patient advocate and functions as a liaison between the patient and payer to answer reimbursement questions and avoid insurance delays.
  • Researches additional or alternative resources for non-covered chemotherapy services to prevent payment denials. Provides a contact list for patients community resources including special programs, drugs and pharmaceutical supplies and financial resources.
  • Maintains a good working knowledge of authorization requirements for all payers, State and federal regulatory guidelines for coverage and authorization
  • Adheres to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient's records
  • Other duties as requested or assigned

Qualifications
MINIMUM QUALIFICATIONS:
  • High school diploma or equivalent required
  • Associates degree in Healthcare, LPN state license and registration preferred
  • Minimum three (3) years medical insurance verification and authorization required

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 ENVIRONMENT:
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.
Successful candidates will thrive in a fast-paced, rapidly changing environment and have a passion for caring for their patients.
Ready For Your Next Career Challenge? We'd Love to Hear from You!
If you possess the above qualifications and a desire to make a difference, we invite you to submit your resume and apply. In addition to a great career opportunity, we offer excellent benefits, a team environment, professional development, and the chance to be part of a nationwide network dedicated to fighting the war against cancer. To apply please click on the "Apply" link.
The US Oncology Network is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability, or protected veteran status. This employer participates in E-Verify.

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