As a Psychologist Reviewer at Centene, you will authorize, direct, and monitor care for behavioral health and substance abuse problems based on clinical information and internal criteria for medical necessity and appropriateness of care. This role involves conducting peer reviews with psychologists and licensed therapists/certified Behavior Analysts for outpatient and/or psychological testing requests, interacting with network practitioners to provide education on best practice models, and facilitating outpatient rounds. The position is remote and requires a PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field, along with a Psychologist Unrestricted License (PhD or PsyD) or Board Certified Behavior Analyst (BCBA-D) upon hire.

Psychologist Reviewer

Molina Healthcare of Florida is seeking Claims Examiners for remote positions based in Florida. This entry-level role involves administering claims payments, maintaining claim records, and ensuring timely settlement in accordance with cost control standards. Candidates with Health Insurance call center experience are encouraged to apply for the opportunity to grow and advance within the company.

Claims Examiner (Medical) -Remote In Florida Only

Claims Examiner (Medical)

The Claims Assistant at Sedgwick provides support to the claims staff and performs other office tasks depending on the client program. This role involves setting up and entering new claims into the claims management system, processing payments, handling mail, and providing customer service. The position requires a high school diploma or GED, and six months of clerical or customer service experience. Sedgwick offers a supportive work environment that values diversity, inclusion, and professional growth.

(Remote) Claims Assistant | FL Residents

Claims Assistant

The Onsite Reviewer is responsible for ensuring Ohio Medicaid providers are providing legitimate services, operating within the required Ohio administrative code rules, and conducting site visits using a comprehensive checklist approved by the Ohio Department of Medicaid. This role involves daily travel to various provider locations across Ohio, including overnight stays, and operating independently within a team environment.

Onsite Reviewer - Southwest Cincinnati

Onsite Reviewer

The Peer Review Coordinator at the American Psychological Association (APA) is a skilled communicator and customer service representative responsible for ensuring a high-quality peer review process for authors, reviewers, and editors. This role involves facilitating all aspects of peer review within the journal portfolio, solving problems, and enhancing existing procedures. The coordinator works closely with editors, authors, and reviewers, as well as APA Journals staff, requiring excellent interpersonal and communication skills.

Peer Review Coordinator

The Reviewer I, Medical at US Tech Solutions is a contract position that involves reviewing authorization requests for home health visits or DME (durable medical equipment) using the patient's benefits contract and medical policies. The role is fully remote after an initial onsite training period, requiring strong computer skills and the ability to interact daily with providers, teammates, and medical professionals via phone and text. The ideal candidate will have a diverse background, knowledge of home health or DME, and strong communication skills.

Reviewer I, Medical

The Claims Assessor role involves analyzing and processing complex workers' compensation claims to determine benefits due, managing claims through well-developed action plans to achieve appropriate and timely resolutions, negotiating settlements, calculating and assigning reserves to claims, and managing the litigation process. This position offers a competitive salary, benefits package, and the opportunity to work remotely with a leading company in the insurance industry.

Claims Assessor

Joule is seeking US Board Certified Medical Doctors, Nurse Practitioners, Physician's Assistants, or Pharmacists licensed in the US for the role of Medical Reviewer. This remote position involves performing medical reviews of short, consumer-facing articles or specific parts of the care journey, adhering to protocols and rubric standards. The role requires recent patient and healthcare experience within the United States.

Medical Reviewer

This job is responsible for submitting claims in accordance with payer regulations and applicable guidelines. The role involves facilitating the overall claim process through submission of both electronic and paper-based claims, resolution of claim-form edits, and validation of data integrity. The position requires an understanding of detailed billing requirements, claims attachments, and claim rejections, as well as attention to detail and the ability to accurately and timely troubleshoot/resolve questions/issues.

Claims Processor

As a Clinical Reviewer at Acentra Health, you will evaluate medical records against precise criteria to determine the medical necessity and care appropriateness of psychiatric inpatient care. This role involves critical thinking, decisive skills, and adherence to regulatory standards to ensure the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process. This full-time remote position is based in Maine, requiring a Maine LCSW or LCPC license and residing and working within the state.

Clinical Reviewer - Remote within Maine - (LCSW or LCPC)

Clinical Reviewer

The Compliance Reviewer at HEALTH AND HUMAN SERVICES COMMISSION performs advanced technical and professional reviews of certification surveys, licensure inspections, and investigations conducted in long-term care facilities to ensure compliance with state/federal requirements and protocols. This role involves transforming qualitative data into quantitative data, assisting with in-depth analysis of program-specific data, and developing work plans, reports, and documentary support for program development and assessment. The position requires knowledge of NFPA codes and standards, principles of documentation, and the ability to work remotely.

Compliance Reviewer

As a Psychologist Reviewer at Centene Corporation, you will authorize, direct, and monitor care for behavioral health and substance abuse problems based on clinical information and internal criteria for medical necessity and appropriateness of care. This role involves conducting peer reviews with psychologists and licensed therapists/certified Behavior Analysts for outpatient and/or psychological testing requests, interacting with network practitioners to provide education on best practice models, and facilitating outpatient rounds. The position is remote and requires a PhD in Clinical Psychology, Counseling, Behavior Analysis, or a related field, along with a PSY - Psychologist Unrestricted License (PhD or PsyD) or a Board Certified Behavior Analyst (BCBA-D) upon hire.

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Remote Claims Reviewer Jobs Hiring Now

Psychologist Reviewer

Claims Examiner (Medical) -Remote In Florida Only

(Remote) Claims Assistant | FL Residents

Onsite Reviewer - Southwest Cincinnati

Peer Review Coordinator

Reviewer I, Medical

Claims Assessor

Medical Reviewer

Claims Processor

Clinical Reviewer - Remote within Maine - (LCSW or LCPC)

Compliance Reviewer

Psychologist Reviewer