Medical / Health Claims Examiner Salary
Health Claims Examiners in the United States are largely women. The group as a whole has a nationwide average of $17.38 per hour for pay. Career length and the particular city each impact pay for this group, with the former having the largest influence. A large number report receiving medical coverage from their employers and a fair number collect dental insurance. Job satisfaction is reported as high by the vast majority of workers.
|Salary||$30,037 - $56,512|
|Bonus||$-0.49 - $2,013|
|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).)
|$27,614 - $53,380|
|Hourly Rate||$12.46 - $22.92|
|Overtime||$15.90 - $35.06|
|Bonus||$-0.49 - $2,013|
|Total Pay (||$27,614 - $53,380|
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.
Pay by Experience Level for Medical / Health Claims Examiner
Pay by Experience for a Medical / Health Claims Examiner has a positive trend. An entry-level Medical / Health Claims Examiner with less than 5 years of experience can expect to earn an average total compensation of $33,000 based on 64 salaries provided by anonymous users. Average total compensation includes tips, bonus, and overtime pay. A Medical / Health Claims Examiner with mid-career experience which includes employees with 5 to 10 years of experience can expect to earn an average total compensation of $40,000 based on 52 salaries. An experienced Medical / Health Claims Examiner which includes employees with 10 to 20 years of experience can expect to earn an average total compensation of $39,000 based on 63 salaries. A Medical / Health Claims Examiner with late-career experience which includes employees with greater than 20 years of experience can expect to earn an average total compensation of $42,000 based on 29 salaries.
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Key Stats for Medical / Health Claims Examiner
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