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Remote Claim Reviewer Jobs (NOW HIRING)

UnitedHealthcare

Clinical Claim Review | , |

This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you ... Review medical and administrative records for audit/compliance review * Travel to provider sites up ...

divvyDOSE

Clinical Claim Review | , |

This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you ... Review medical and administrative records for audit/compliance review * Travel to provider sites up ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and ... This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and ... This position is Remote in Massachusetts. You will have the flexibility to work remotely* as you ...

MedReview

DRG Reviewer

Manhattan, NY · On-site +1

$85K - $90K/yr

This is a fully remote position. Candidates must be available to work Eastern Standard Time (EST ... Maintains 95% accuracy in claim reviews. * Must be available to work a 7.5-hour workday during ...

MedReview

DRG Reviewer

Manhattan, NY · Remote

This is a fully remote position. Candidates must be available to work Eastern Standard Time (EST ... Maintains 95% accuracy in claim reviews. * Must be available to work a 7.5-hour workday during ...

Sentara Health

Clinical Claims Reviewer/ RN

Norfolk, VA · Remote

$66K - $111K/yr

Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware ... Primary responsibilities include conducting comprehensive claim reviews both pre and post payment ...

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Remote Claim Reviewer information

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$30.5K

$64.6K

$90K

How much do remote claim reviewer jobs pay per year?

As of Sep 13, 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

What cities are hiring for Remote Claim Reviewer jobs?

Cities with the most Remote Claim Reviewer job openings:

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 are popular job titles related to Remote Claim Reviewer jobs?

For Remote Claim Reviewer jobs, the most frequently searched job titles are:

Remote Claim Reviewer jobs near you
Infographic showing various Remote Claim Reviewer job openings in the United States as of September 2026, with employment types broken down into 81% Full Time, 5% Part Time, and 14% Contract. Highlights an 5% In-person, and 95% Remote job distribution, with an average salary of $64,609 per year, or $31.1 per hour.

Medical Claim Reviewer (CGS, DMEC-B)

OR • On-site, Remote

Broadway Ventures
Business Management Consulting • 11 - 50 employees
Learn more about Broadway Venturesexternal

Full-time

Re-posted 19 days ago

Job description

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 QualificationsLicensure:
  • 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.

Apply