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Medical / Health Claims Examiner Salary

Health Claims Examiners in the United States take home an average $17.30 per hour. Most Health Claims Examiners report high levels of job satisfaction. Female Health Claims Examiners far outnumber their male contemporaries among survey respondents. Medical benefits are awarded to most, and a majority earn dental coverage. Figures cited in this summary are based on replies to PayScale's salary questionnaire.

$29,637 - $53,724
(Median)
$30K
$40K
$54K
MEDIAN: $39,707
10%
50%
90%

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$12.22 - $22.72
(Median)
$12
$17
$23
MEDIAN: $17.00
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$18K$36K$54K
Salary
$29,637 - $53,724  
   
Bonus
$0.00 - $2,982  
Profit Sharing
$300.00 - $3,000  
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).
)
$27,243 - $51,830  
Country: United States | Currency: USD | Updated: 2 May 2015 | Individuals Reporting: 108
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$12$24$36
Hourly Rate
$12.22 - $22.72  
   
Overtime
$17.39 - $33.16  
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$24K$48K$72K
Bonus
$0.00 - $2,982  
   
Profit Sharing
$300.00 - $3,000  
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).
)
$27,243 - $51,830  
Country: United States | Currency: USD | Updated: 2 May 2015 | Individuals Reporting: 186

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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.

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.


Health Claims Examiners with more experience do not necessarily bring home bigger paychecks. In fact, experience in this field tends to impact compensation minimally. Those who have worked for fewer than five years take home a median salary of $36K, and workers with five to 10 years of experience earn a higher $38K on average. For Health Claims Examiners, 10 to 20 years of experience on the job amounts to an average salary of $40K. Health Claims Examiners who surpass 20 years on the job report pay that isn't as high as one would expect; the median compensation for this crowd sits around $41K.

Related Job Salaries

United States (change)

Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 8%

Experienced
up arrow 4%

National Average
$38,000

Mid-Career
up arrow 2%

Entry-Level
up arrow 6%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 52 votes.

Gender

Female
90 %
Male
10 %

Years of Experience

Less than 1 year
5%
1-4 years
28%
5-9 years
24%
10-19 years
22%
20 years or more
20%

Common Health Benefits

medical benefits Medical: 80% dental benefits Dental: 69%
vision benefits Vision: 59% employee benefits None: 17%
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