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Remote Claim Reviewer Jobs (NOW HIRING)

CorroHealth

Claim Review Specialist

$18.50 - $24.50/hr

This is a remote position ESSENTIAL DUTIES AND RESPONSIBILITIES: Note: The essential duties and ... Audit all aspects of claim including (but not limited to): -Omitted or incorrect charges, -Review ...

MSIG Holdings USA, Inc.

Claim Account Executive

Warren, NJ · On-site +1

$150K - $180K/yr

Conduct onsite visits, claim reviews, and stewardship meetings as appropriate. Claims Service ... REMOTE OR #LI-HYBRID It's an exciting time for our company and a great opportunity to join a ...

Berkley

Stop Loss Claims Analyst

San Antonio, TX · Remote

$70K - $80K/yr

... Remote The company is an equal employment opportunity employer. As a Stop Loss Claims Analyst, you'll perform quality review and evaluation of all claim submissions received and logged into our ...

Berkley

Stop Loss Claims Analyst

San Antonio, TX · Remote

$70K - $80K/yr

... Remote The company is an equal employment opportunity employer. Responsibilities As a Stop Loss Claims Analyst, you'll perform quality review and evaluation of all claim submissions received and ...

US Tech Solutions

Medical Reviewer LPN #

Columbia, SC · Remote

$23/hr

Onsite 1-2 weeks, then will work remote. * Will be required to come onsite as needed for meetings ... Performs medical claim reviews and makes a reasonable charge payment determination. * Monitors ...

Crawford and Company

Sr Claim Examiner- WC

Dallas, TX · Remote

$32.50 - $44/hr

We're Hiring: Sr. Claim Examiner - WC (Remote) Ready to take on highstakes claims and make a real ... What You'll Do Review coverage, determine liability, and drive fair resolutions Secure critical ...

Ourhrconnect

Medical Reviewer II

Carolina, RI · On-site +1

Six-week paid training class with one week of onsite training and five weeks of remote training ... Perform medical claim reviews for one or more of the following: claims for medically complex ...

Ourhrconnect

Medical Reviewer II

Alabama, NY · On-site +1

Six-week paid training class with one week of onsite training and five weeks of remote training ... Perform medical claim reviews for one or more of the following: claims for medically complex ...

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All JobsRemote Claim Reviewer Jobs

Remote Claim Reviewer information

See salary details

$30.5K

$64.6K

$90K

How much do remote claim reviewer jobs pay per year?

As of Jun 20, 2026, the average yearly pay for remote claim reviewer in the United States is $64,609.00, according to ZipRecruiter salary data. Most workers in this role earn between $51,000.00 and $75,500.00 per year, depending on experience, location, and employer.

What is the difference between Remote Claim Reviewer vs Remote Claims Processor?

AspectRemote Claim ReviewerRemote Claims Processor
Required CredentialsHigh school diploma or equivalent; insurance knowledge often preferredHigh school diploma or equivalent; basic insurance or data entry skills
Work EnvironmentHome-based, independent review settingHome-based, processing claims and data entry
Industry UsageInsurance companies, third-party administratorsInsurance companies, healthcare providers
Common Search IntentComparing roles involving claim review and evaluationRoles focused on processing and data entry of claims

The main difference is that Remote Claim Reviewers evaluate and assess insurance claims for accuracy and validity, often requiring insurance knowledge. Remote Claims Processors handle the entry and processing of claims, focusing on data entry and administrative tasks. Both roles are remote and industry-specific but differ in responsibilities and skill requirements.

More about Remote Claim Reviewer jobs
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What are the most commonly searched types of Claim Reviewer jobs? The most popular types of Claim Reviewer jobs are:
What states have the most Remote Claim Reviewer jobs? States with the most job openings for Remote Claim Reviewer jobs include:
What job categories do people searching Remote Claim Reviewer jobs look for? The top searched job categories for Remote Claim Reviewer jobs are:
Remote Claim Reviewer jobs near you

Medical Claim Reviewer (CGS, DMEC)

Broadway Ventures

Remote

Full-time

Posted 23 days ago

Job description

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation.
Max Salary: W-2 ($65,000/$31.25)
Location: Remote (U.S. - Work from home)
Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office
Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed.
About the Role
We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
Key Responsibilities
  • Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
  • Assess payment determinations using clinical information and established guidelines.
  • Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
  • Provide clear, well-documented rationales for service approvals or denials.
  • Educate internal and external teams on medical review processes, coverage determinations, and coding requirements.
  • Support quality control activities to meet corporate and team objectives.
  • Provide guidance to LPN team members and support non-clinical staff through training and discussions.
  • Assist with special projects and additional responsibilities as assigned.
Minimum Qualifications
Licensure:
  • Active, unrestricted RN license in the U.S. and in the state of hire
    OR
  • Active compact multistate RN license (as defined by the Nurse Licensure Compact).
Education:
  • Associate Degree in Nursing
    OR
  • Graduate of an accredited School of Nursing.
Experience:
  • Two years of clinical experience.
Skills & Competencies:
  • Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings.
  • Ability to interpret and apply medical review criteria and clinical guidelines.
  • Proficiency in Microsoft Office and word processing software.
  • Strong analytical, organizational, and decision-making skills.
  • Ability to work independently while managing priorities effectively.
  • Excellent customer service, communication, and critical thinking skills.
  • Ability to handle confidential information with discretion.

What to Expect Next:
After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting.
Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law.
Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).

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