How to hire a claims reviewer

How to hire a claims reviewer, step by step

Here's a step-by-step claims reviewer hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a claims reviewer job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new claims reviewer
• Step 8: Go through the hiring process checklist

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1. Identify your hiring needs

   The claims reviewer hiring process starts by determining what type of worker you actually need. Certain roles might require a full-time employee, whereas part-time workers or contractors can do others.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   A claims reviewer's background is also an important factor in determining whether they'll be a good fit for the position. For example, claims reviewers from different industries or fields will have radically different experiences and will bring different viewpoints to the role. You also need to consider the candidate's previous level of experience to make sure they'll be comfortable with the job's level of seniority.

   This list presents claims reviewer salaries for various positions.

   Type of Claims Reviewer	Description	Hourly rate
   Claims Reviewer	Customer service representatives interact with customers to handle complaints, process orders, and provide information about an organization’s products and services.	$14-25
   Member Service Representative	A member service representative is responsible for providing customer service support to an organization. Member service representatives' duties include responding to customer's inquiries and complaints, developing effective sales pitches, processing customer's requests and orders, creating reports, developing recommendations to improve the operation's performance, and escalating high-level concerns... Show more	$10-21
   Representative	Representatives are lawmakers who represent the people in a specific district. They run for office to represent their districts in their hometown or their current place of living... Show more	$11-26

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Home Health
   • Insurance Claims
   • Data Entry
   • Medical Terminology
   • CPT
   • Claims Submission
   • BP
   • Medical Claims
   • Regular Quality Control
   • CMS
   • Loss Statements
   • Oil Spill
   • Computer System
   • Medical Necessity

   Check all skills

   Responsibilities:

   • Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
   • Review worker comp claims base on state fee schedule and ICD-9 guidelines.
   • Research ICD-9 codes and verify they are equivalent with customer s diagnoses.
   • Review accounts per OCC guidelines that all efforts are met and due diligence complete.
   • Research claims, review document findings and execute OCC approve harm test for each file.
   • Help maintain company compliance with FDA and ICH Regulations/Guidelines governing the reporting of adverse event reports.

3. Make a budget

   Including a salary range in your claims reviewer job description is one of the best ways to attract top talent. A claims reviewer can vary based on:

   • Location. For example, claims reviewers' average salary in mississippi is 54% less than in washington.
   • Seniority. Entry-level claims reviewers 44% less than senior-level claims reviewers.
   • Certifications. A claims reviewer with certifications usually earns a higher salary.
   • Company. Working for an established firm or a new start-up company can make a big difference in a claims reviewer's salary.

   Average claims reviewer salary

   $41,011yearly

   $19.72 hourly rate

   ---

   Entry-level claims reviewer salary

   $30,000 yearly salary

   Updated February 4, 2026

4. Writing a claims reviewer job description

   A claims reviewer job description should include a summary of the role, required skills, and a list of responsibilities. It's also good to include a salary range and the first name of the hiring manager. To help get you started, here's an example of a claims reviewer job description:

   Claims reviewer job description example

   Ensures the integrity of outside medical payments for the organization by verifying the accuracy of data-entered information and by reviewing claims-related information and invoice adjudication/payment for compliance with contract terms and according to department/regional policy and procedures. Conducts research, assists with problem resolution within specialized areas such as Medicare, Multiplan, Workers' Compensation, Coordination of Benefits and Third Party liability. May provide education and feedback to staff involved in related processes and may assist with recovery of funds and response to appeals.
   Essential Functions:
   
   - Analyzes referrals and claims information for accuracy according to established guidelines.
   
   - Provides education, feedback and reports as applicable.
   
   - Assists with tracing sources of inaccuracies.
   
   - Reports and proposes remedial action to appropriate manager.
   
   - Prepares detailed analysis of claims activity and submits reports/findings as requested.
   
   - Maintains records of special processing payment adjustments and check requests.
   
   - Works with other departments as a resource regarding all aspects of Outside Medical Claims.
   
   - Researches and provides reports as requested.
   
   - Reviews processing of outside medical payments on a continuous basis.
   
   - Audits and verifies documentation, approvals and accurate coding of provider service and accounting data.
   
   - Monitors and coordinates special transactions, e.g., check adjustments and credits.
   
   - Performs data analysis for outside medical payments and provides performance feedback.
   
   - Formats and prepares statistical reports to assist with budget monitoring and financial analysis.
   
   - Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding.
   
   - Prepares special comprehensive reports as indicated or requested by management.
   
   - May provide education and feedback to staff involved in related processes.
   
   - May assist with recovery of funds and providing timely response to appeals.
   
   Basic Qualifications:
   
   - Two (2) years of claims analysis and medical billing experience.
   
   - High School diploma or GED required.
   
   - Knowledge of CPT, ICD, RBRVS, and other applicable references.
   
   - Familiarity with outside medical systems and claims processing/adjudication processes.
   
   - Demonstrated knowledge of both mainframe and personal computer programs.
   
   - Excellent mathematical, written and verbal skills and demonstrated medical terminology competence.
   
   - Demonstrated ability to act under limited supervision.
   
   - Ability to understand, develop and implement procedures.
   
   Preferred Qualifications:
   
   - Bachelor's degree in accounting, audit, finance or a related field preferred.
   
   COMPANY: KAISER
   
   TITLE: Claims Reviewer ASC
   
   LOCATION: Bakersfield, California
   
   REQNUMBER: 1108518
   
   External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.

   Copy this example

   

5. Post your job

   There are a few common ways to find claims reviewers for your business:

   • Promoting internally or recruiting from your existing workforce.
   • Ask for referrals from friends, family members, and current employees.
   • Attend job fairs at local colleges to meet candidates with the right educational background.
   • Use social media platforms like LinkedIn, Facebook, and Twitter to recruit passive job-seekers.

   Post your job online:

   • Post your claims reviewer job on Zippia to find and recruit claims reviewer candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   Recruiting claims reviewers requires you to bring your A-game to the interview process. The first interview should introduce the company and the role to the candidate as much as they present their background experience and reasons for applying for the job. During later interviews, you can go into more detail about the technical details of the job and ask behavioral questions to gauge how they'd fit into your current company culture.

   You should also ask about candidates' unique skills and talents to see if they match the ideal candidate profile you developed earlier. Candidates good enough for the next step can complete the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new claims reviewer

   Once you've selected the best claims reviewer candidate for the job, it's time to write an offer letter. In addition to salary, this letter should include details about the benefits and perks you offer the candidate. Ensuring that your offer is competitive is essential, as qualified candidates may be considering other job opportunities. The candidate may wish to negotiate the terms of the offer, and you should be open to discussion. After you reach an agreement, the final step is formalizing the agreement with a contract.

   It's also good etiquette to follow up with applicants who don't get the job by sending them an email letting them know that the position has been filled.

   To prepare for the new employee's start date, you can create an onboarding schedule and complete any necessary paperwork, such as employee action forms and onboarding documents like I-9 forms, benefits enrollment, and federal and state tax forms. Human Resources should also ensure that a new employee file is created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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