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Pacer Group

HEDIS Data Reviewer

Philadelphia, PA · On-site

HEDIS Data Reviewer Location: Philadelphia, PA 19113 (Hybrid) Duration: 3 Months Schedule: Standard ... Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and ...

Pacer Group

HEDIS Data Reviewer

Philadelphia, PA · On-site

$40 - $44/hr

HEDIS Data Reviewer Location: Philadelphia, PA 19113, USA Duration: 3 Months Schedule: Standard ... Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and ...

Far Inspections

Vacancy Reviewer

Watseka, IL · On-site

$25 - $35/hr

Flat-Rate Pay: This is a 1099 position where you are paid a set fee for every inspection completed. * Earning Potential: While pay is per-inspection, efficient contractors typically earn the ...

Far Inspections

Vacancy Reviewer

Watseka, IL · On-site

$25 - $35/hr

Flat-Rate Pay: This is a 1099 position where you are paid a set fee for every inspection completed. * Earning Potential: While pay is per-inspection, efficient contractors typically earn the ...

A-Line Staffing Solutions

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Medical Records Reviewer

Harrisburg, PA · On-site

$20 - $22.50/hr

Harrisburg, PA 17120 Pay Rate: $20-22.50 per hour based on experience Schedule: Monday - Friday, 8:00 AM - 4:00 PM Position Overview: This position supports the review and evaluation of outpatient ...

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Welo Data

German Bilingual Lyric Reviewer

Charleston, WV · Remote

$17 - $18/hr

Welo Data is looking for a German Lyric Reviewer to help us train cutting-edge AI. This role is ... Provide quality ratings based on predefined criteria. * Identify and flag translation issues ...

Healthfirst., Inc.

Medical Peer Reviewer

... Rater Reliability (IRR) Testing • Complies with the Healthfirst Conflict of Interest Policy for ... will be reviewed at the e-mail address and phone number supplied. Thank you for considering a ...

Verisk

MSA Nurse Reviewer

Woburn, MA · On-site

Verisk Businesses Underwriting Solutions - provides underwriting and rating solutions for auto and ... review reports, medical bill reviews and utilization reviews in injury cases preferred ...

Verisk

MSA Nurse Reviewer

Woburn, MA · On-site

$80K - $88K/yr

This includes reviewing records, preparing the narrative and an appropriate allocation for medical ... Verisk Businesses Underwriting Solutions - provides underwriting and rating solutions for auto and ...

Verisk

MSA Nurse Reviewer

Woburn, MA · On-site

This includes reviewing records, preparing the narrative and an appropriate allocation for medical ... Verisk Businesses Underwriting Solutions - provides underwriting and rating solutions for auto and ...

BerryDunn

Per Diem Coding & OASIS Reviewer

$32 - $37/hr

This is a remote position requiring the Reviewer to work independently. Our Healthcare ... This rate range represents BerryDunn's good faith and reasonable estimate of the possible ...

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How much do rate reviewer jobs pay per hour?

As of Jun 6, 2026, the average hourly pay for rate reviewer in the United States is $29.88, according to ZipRecruiter salary data. Most workers in this role earn between $22.60 and $36.54 per hour, depending on experience, location, and employer.

What is the difference between Rate Reviewer vs Claims Adjuster?

AspectRate ReviewerClaims Adjuster
Required CredentialsTypically a high school diploma or equivalent; some roles prefer insurance or finance certificationsHigh school diploma or equivalent; often requires state licensing or certification
Work EnvironmentOffice-based, reviewing insurance rates and policiesField and office-based, investigating and settling insurance claims
Employer & Industry UsageInsurance companies, financial institutionsInsurance companies, public agencies
Comparison Search IntentUnderstanding role differences, job requirements, or career pathsComparing job responsibilities, qualifications, or career options

Both roles are integral to the insurance industry, but a Rate Reviewer primarily evaluates and approves insurance rates, while a Claims Adjuster investigates and settles claims. Understanding these differences helps job seekers identify the right career path based on their skills and interests.

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

To thrive as a Rate Reviewer, you need strong analytical abilities, attention to detail, and a background in finance, insurance, or a related field—often supported by a bachelor's degree. Familiarity with regulatory compliance tools, actuarial software, and data management systems is typically required. Excellent written communication, objectivity, and organizational skills help you navigate complex regulations and present findings clearly. These competencies ensure accurate rate assessments, regulatory compliance, and effective collaboration with stakeholders.

What are Rate Reviewers?

Rate Reviewers are professionals who evaluate and analyze proposed rates, often within industries like insurance, utilities, or healthcare. Their primary responsibility is to ensure that rates set by companies are fair, reasonable, and comply with regulatory standards. They review detailed documentation, financial data, and justifications for rate changes to protect consumer interests and maintain industry transparency. Rate Reviewers often work for government agencies, regulatory bodies, or large organizations.

What are some common challenges faced by Rate Reviewers and how can they be managed effectively?

Rate Reviewers frequently encounter the challenge of analyzing complex data sets and ensuring compliance with evolving regulatory standards. Staying current with industry regulations and maintaining strong attention to detail are essential for success. Effective collaboration with actuaries, underwriters, and regulatory agencies also helps to resolve discrepancies and ensure accurate rate filings. Developing strong analytical and communication skills can help Rate Reviewers address these challenges and contribute to the organization's compliance and profitability.
More about Rate Reviewer jobs
What cities are hiring for Rate Reviewer jobs? Cities with the most Rate Reviewer job openings:
What states have the most Rate Reviewer jobs? States with the most job openings for Rate Reviewer jobs include:
What job categories do people searching Rate Reviewer jobs look for? The top searched job categories for Rate Reviewer jobs are:
Rate Reviewer jobs near you
Infographic showing various Rate Reviewer job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, 70% Full Time, 21% Part Time, and 8% Contract. Highlights an 70% Physical, 3% Hybrid, and 27% Remote job distribution, with an average salary of $62,159 per year, or $29.9 per hour.
HEDIS Data Reviewer

HEDIS Data Reviewer

Pacer Group

Philadelphia, PA • On-site

Contractor

Posted 2 days ago

Job description

Position Title: HEDIS Data Reviewer

Location: Philadelphia, PA 19113 (Hybrid)

Duration: 3 Months

Schedule: Standard 8 am -5:30 pm EST

 

Summary:

Under the direction of the Manager of Medical Record Review Operations, the HEDIS Data Reviewer is responsible for performing medical record abstraction and overread in support of Quality reporting (annual Healthcare Effectiveness Data and Information Set (HEDIS) and State EQRO) with duties including but not limited to the following:

Responsibilities:

  • Coordination of the medical records identification process, collection activities and review.
  • Performing and applying structured auditing abstraction criteria to medical records to determine compliance.
  • Utilizing various software applications to support department operations and accurately entering the results of chart audits into the database.
  • Developing and maintaining expertise in the requirements and parameters of mandated HEDIS and State performance measures.
  • Completing medical record review abstraction and overread and providing feedback for medical records that do not meet the HEDIS or State Measure Technical Specifications criteria within a live software environment.
  • Providing clinical and administrative support to providers as directed.
  • Maintaining productivity level of a minimum of chases/charts per defined period according to policy.
  • Maintaining an abstraction proficiency rate of 98% by correctly reading, interpreting, and abstracting various components of the medical record such as notes, consultations, medication forms, treatment plans, health history, interval history, and past history.
  • Assisting in the medical record collection process including making phone calls, sending out faxes/letters or chart retrieval requests to providers as assigned.
  • Completing additional designated projects assigned and deemed as necessary."

Requirement:

  • Three to five years working with HEDIS data including chart review/collection. HEDIS, QRS, or STARs experience. Knowledge of medical terminology and basic charting to include diabetic labs, HPV testing, preventive health screenings, immunization and well-care terminology for children, adults and pregnant women.
  • Understanding of current HEDIS Technical Specifications.
  • Knowledgeable in the HEDIS audit process (PSV, CSV and MRRV).
  • Proficiency in Excel, Word, Power Point and Outlook.
  • Experience with medical record abstraction tool(s) and wiliness to learn any medical record abstraction tool.
  • Experience in the Pediatric, Maternity, Diabetic or Provider Office Setting.
  • Familiar with the Cancer Registry.
  • Familiar with Bright Futures.
  • Strong written and oral communication skills, critical thinking skills, strong organizational skills.
  • Able to think and work independently, effectively, and under pressure of deadlines."