Physician ED Claims Reviewer
The Judge Group
Remote
Posted on May 5, 2026
Our client is currently seeking a Physician ED Claims Reviewer
This job will have the following responsibilities:
This job will have the following responsibilities:
Professional Summary (JD‑Aligned):
- US‑licensed Physician with 3–5 years of recent clinical experience, primarily in Emergency Department medicine, with additional exposure to Internal Medicine and complex acute care decision‑making.
- Experienced in managed care clinical review, conducting utilisation management (UM) authorisation reviews and claims adjudication to determine medical necessity in accordance with evidence‑based guidelines.
- Strong working knowledge of medical coding standards (CPT/HCPCS) and their application in claims review, reimbursement validation, and compliance with payer policies.
- Proven ability to work independently in a fast‑paced environment, managing high‑volume UM cases while maintaining accuracy, regulatory compliance, and turnaround time metrics.
- Proficient in using multiple clinical systems and applications, with a detail‑oriented approach to documentation, case analysis, and cross‑functional collaboration within managed care settings.
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