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Remote Claim Reviewer Jobs (NOW HIRING)

ePATHUSA Inc

Medical Review Nurse

Clive, IA · Remote

$80K - $90K/yr

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on applicable Medicare ...

Machinify

Nurse Itemized Bill Reviewer (IBR Analyst)

$80K - $90K/yr

Recommend system enhancements and edits to improve claim review efficiency. * Comply with company ... Proven success in a remote working environment * Proficient in Windows office systems, including ...

A-G Specialty Insurance, LLC

Claim Examiner

Berwyn, PA · Remote

$50K/yr

Establish proof of loss by reviewing medical documentation; assembling additional information as ... The role is open to candidates who are in a fully remote, hybrid, or on-site role. One full week of ...

Corvel

Claim Specialist Floater

Overland Park, KS · Remote

$25.48 - $41.09/hr

This is a remote role. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: * Receives claims, confirms policy ... Adheres to client and carrier guidelines and participates in claims review as needed * Assists ...

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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 Jun 21, 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.

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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 Review Nurse

Medical Review Nurse

ePATHUSA Inc

Clive, IA • Remote

$80K - $90K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 15 days ago

Job description

This is a remote position.

Seeking Registered Nurse for fully remote role to perform complex medical record and claim reviews (Standard or Program Integrity) to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, clinical review judgment and when appropriate, monitor for potential indicators of fraud, waste, and abuse. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Medical Review Accuracy Contract (MRAC).

Essential Functions

  • Perform complex medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
  • Accurately enter medical review data into the medical review system.
  • Apply clinical review judgment, based on clinical experience when applicable and review completeness of documentation to determine if documentation supports claim as billed.
  • Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
  • When performing Program Integrity (PI) reviews, assess investigative allegations and medical review findings, and/or other claims data to determine patterns and detect potential indicators of fraud, waste and abuse (FWA).
  • Accurately identify additional findings in the review of evidence of potential FWA not detected by the Medical Review Contractor.
  • Consistently meet or exceed productivity and accuracy standards of 98% minimum


Requirements
  • Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
  • A Bachelor’s Degree in Nursing (BSN) or other related field is preferred.
  • Certification in coding highly preferred.
  • A minimum of five (5) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
  • A minimum of three (3) or more years’ experience in medical review for payment accuracy, particularly with Medicare Part A, Skilled Nursing Facility, and/or Home Health
  • Minimum of 2 (two) years’ experience in the medical review processes of MACs, SMRC, and/or UPICs.
  • Desired experience performing medical review for fraud, waste, and abuse (FWA) investigations.
  • Knowledgeable of ICD-9-CM, ICD-10, CPT-4 and HCPCS coding.
  • One year or more of utilizing InterQual and/or Milliman guidelines against inpatient services experience is preferred.


Benefits

Benefit Package includes:

  • Paid Sick Time
  • Insurance for Medical, Dental, Vision and Life Available
  • 401(k) including Employer Match
  • HSA, Short-term & Long-term Disability Available
  • We are an EEO/Veterans/Disabled employer.