Medical / Health Claims Examiner Salary

Health Claims Examiners in the United States are largely female. The average salary of the entire group is approximately $17.17 per hour. Career length and the particular city each impact pay for this group, with the former having the largest influence. Most Health Claims Examiners like their work and job satisfaction is high. A fair number report receiving medical coverage from their employers and more than half collect dental insurance. The figures in this rundown are based on the results of PayScale's salary questionnaire.

$29,993 - $54,577
(Median)
$30K
$41K
$55K
MEDIAN: $40,593
10%
50%
90%

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$12.08 - $22.75
(Median)
$12
$17
$23
MEDIAN: $17.00
10%
50%
90%

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National Salary Data (?
XAll compensation data shown are gross 10th to 90th percentile ranges. Take the PayScale Survey to find out how location influences pay for this job.
)
$0$19K$38K$57K
Salary
$29,993 - $54,577  
   
Bonus
$0.00 - $3,009  
Profit Sharing
$1,600  
Total Pay (?
XTotal Pay combines base annual salary or hourly wage, bonuses, profit sharing, tips, commissions, overtime pay and other forms of cash earnings, as applicable for this job. It does not include equity (stock) compensation, cash value of retirement benefits, or the value of other non-cash benefits (e.g. healthcare).
)
$26,934 - $52,435  
Country: United States | Currency: USD | Updated: 12 Jan 2016 | Individuals Reporting: 106
National Hourly Rate Data (?
XAll compensation data shown are gross 10th to 90th percentile ranges. Take the PayScale Survey to find out how location influences pay for this job.
)
$0$11$22$33
Hourly Rate
$12.08 - $22.75  
   
Hourly Tips
$0.64  
Overtime
$14.68 - $31.91  
National Annualized Data (?
XAll compensation data shown are gross 10th to 90th percentile ranges. Take the PayScale Survey to find out how location influences pay for this job.
)
$0$22K$44K$66K
Bonus
$0.00 - $3,009  
   
Profit Sharing
$1,600  
Total Pay (?
XTotal Pay combines base annual salary or hourly wage, bonuses, profit sharing, tips, commissions, overtime pay and other forms of cash earnings, as applicable for this job. It does not include equity (stock) compensation, cash value of retirement benefits, or the value of other non-cash benefits (e.g. healthcare).
)
$26,934 - $52,435  
Country: United States | Currency: USD | Updated: 12 Jan 2016 | Individuals Reporting: 185
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Job Description for Medical / Health Claims Examiner

Medical and health claims examiners generally work in an office setting, but may be required to go into the field if a situation requires hands-on investigation. Those in this position serve customers of medical insurance companies by determining insurance coverage, claim examination, and resolution, as well as maintaining and documenting customer service actions and ensuring legal compliance. They also determine covered medical insurance losses according to policies/certificates, establish proof of losses by analyzing medical documentation, provide support to legal actions by assembling documentation for settlements, and, if necessary, assemble further information from outside sources and witnesses.

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Medical / Health Claims Examiner Tasks

  • Examine and verify accuracy and completeness of complex medical claims according to regulatory guidelines.
  • Update claims with additional information as required and monitor itemized billings for unauthorized charges.
  • Make claim settlement determinations to authorize or deny payment based on policy and practices.

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Pay by Experience Level for Medical / Health Claims Examiner

Median of all compensation (including tips, bonus, and overtime) by years of experience.


Health Claims Examiners do not generally earn higher incomes from more experience in the field. Respondents with less than five years' experience take home $35K on average. In contrast, those who have been around for five to 10 years earn a noticeably higher average of $38K. After working for 10 to 20 years, Health Claims Examiners make a median salary of $40K. More than 20 years of experience mean a somewhat bigger median paycheck of $41K, but it's not much more than what less experienced people make.

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Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 6%

Experienced
up arrow 4%

National Average
$38,000

Mid-Career
up arrow 1%

Entry-Level
up arrow 9%

Skills That Affect Medical / Health Claims Examiner Salaries

Claim Handling
up arrow 4%

National Average
$38,000

Medical Coding
up arrow 4%

Medical Terminology
up arrow 8%

Current Procedural Terminology (CPT) Coding
up arrow 13%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 43 votes.

Gender

Female
91 %
Male
9 %

Years of Experience

Less than 1 year
4%
1-4 years
29%
5-9 years
21%
10-19 years
24%
20 years or more
22%

Common Health Benefits

medical benefits
Medical: 79%
dental benefits
Dental: 69%
medical benefits
Vision: 60%
dental benefits
None: 18%
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