Medical / Health Claims Examiner Salary
Women make up the vast majority of Health Claims Examiners in the United States. The average pay in this industry is approximately $17.52 per hour. Career duration and the particular city each impact pay for this group, with the former having the largest influence. Most Health Claims Examiners report high levels of job satisfaction. A large number enjoy medical while a fair number get dental coverage. Vision coverage is also available to a majority. The information for this rundown comes from respondents who completed PayScale's salary questionnaire.
|Salary||$30,152 - $58,257|
|Bonus||$-0.50 - $2,466|
|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).)
|$27,877 - $53,315|
|Hourly Rate||$12.53 - $23.68|
|Overtime||$15.90 - $34.56|
|Bonus||$-0.50 - $2,466|
|Total Pay (||$27,877 - $53,315|
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.Read More...
There are elements of detective work in this position; questionable claims must be investigated and customer confidentiality and privacy concerns must be respected. Claims examiners must document claims actions and fill out required paperwork with meticulous attention to detail and are the first line for approving or denying claims. They are also responsible for calculating due benefits, initiating payments, and composing denial letters.
Because the job also has elements of accounting, investigation, and legal compliance issues, the required skills and qualifications for the position are relatively broad in scope. Experience in the fields of claims adjustment and financial software, as well as skills in documentation, data entry, mathematics, problem-solving, statistical analysis, and customer focus, are also important. They must be familiar with all FDA health regulations, as well.
Those in this position generally work regular hours with holidays and benefits.
Medical / Health Claims Examiner Tasks
- Make claim settlement determinations to authorize or deny payment based on policy and practices.
- Update claims with additional information as required and monitor itemized billings for unauthorized charges.
- Examine and verify accuracy and completeness of complex medical claims according to regulatory guidelines.
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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.
The average worker who claims fewer than five years of experience earns around $34K. In contrast, however, individuals who report five to 10 years in this occupation see a much larger median of $39K. On average, Health Claims Examiners make $39K following one to two decades on the job. Health Claims Examiners who have spent more than 20 years on the job report earning a significantly higher median of $42K.
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Key Stats for Medical / Health Claims Examiner
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