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Medical / Health Claims Examiner Salary

For Health Claims Examiners, hourly average wages total $16.83 per hour. Job satisfaction is high and work is enjoyable for most Health Claims Examiners. Health Claims Examiners who responded to the questionnaire are largely women, dominating at 88 percent. Most enjoy medical while more than half get dental coverage. Vision coverage is also available to a majority.
$29,430 - $55,253
(Median)
$29K
$40K
$55K
MEDIAN: $39,506
10%
50%
90%

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$12.19 - $21.67
(Median)
$12
$17
$22
MEDIAN: $16.00
10%
50%
90%

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National Salary Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$19K$38K$57K
Salary
$29,430 - $55,253  
   
Bonus
$0.00 - $2,978  
Profit Sharing
$101.74 - $1,965  
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).
)
$27,139 - $51,830  
Country: United States | Currency: USD | Updated: 11 Dec 2014 | Individuals Reporting: 109
National Hourly Rate Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$11$22$33
Hourly Rate
$12.19 - $21.67  
   
Overtime
$13.50 - $32.92  
National Annualized Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$22K$44K$66K
Bonus
$0.00 - $2,978  
   
Profit Sharing
$101.74 - $1,965  
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).
)
$27,139 - $51,830  
Country: United States | Currency: USD | Updated: 11 Dec 2014 | Individuals Reporting: 189
United States (change)

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.

Medical / Health Claims Examiner Job Listings

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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.


More years of relevant experience do not necessarily translate to higher paychecks. Those who have worked for fewer than five years take home a median salary of $35K, and workers with five to 10 years of experience earn a higher $37K on average. Health Claims Examiners with one to two decades of relevant experience report an average salary of approximately $40K. People who have worked for more than 20 years report a median income of $41K, which is barely higher than the median for folks with 10 to 20 years of experience.

Related Job Salaries

Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 9%

Experienced
up arrow 5%

National Average
$38,000

Mid-Career
up arrow 1%

Entry-Level
up arrow 6%

Job Satisfaction

Highly satisfied
Rated 4 out of 5
based on 54 votes.

Gender

Female
88 %
Male
12 %

Years of Experience

Less than 1 year
5%
1-4 years
30%
5-9 years
24%
10-19 years
23%
20 years or more
18%

Common Health Benefits

medical benefits Medical: 82% dental benefits Dental: 70%
vision benefits Vision: 57% employee benefits None: 15%