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.

$30,152 - $58,257
$30K
$41K
$58K
MEDIAN: $41,039
10%
50%
90%

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$12.53 - $23.68
$13
$18
$24
MEDIAN: $17.52
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$20K$40K$60K
Salary
$30,152 - $58,257  
   
Bonus
$-0.50 - $2,466  
Profit Sharing
$1,250  
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  
Country: United States | Currency: USD | Updated: 18 Jan 2017 | Individuals Reporting: 52
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$12$24$36
Hourly Rate
$12.53 - $23.68  
   
Overtime
$15.90 - $34.56  
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$24K$48K$72K
Bonus
$-0.50 - $2,466  
   
Profit Sharing
$1,250  
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  
Country: United States | Currency: USD | Updated: 18 Jan 2017 | Individuals Reporting: 130

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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

  • 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.

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.


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.

Related Job Salaries

Key Stats for Medical / Health Claims Examiner

Gender

Female
93 %
Male
7 %

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 26 votes.
030
Less than 1 year
5%
1-4 years
27%
5-9 years
19%
10-19 years
31%
20 years or more
18%
Location:
Years in Fields/Career:
United States (change)

Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 10%

Mid-Career
up arrow 4%

Experienced
up arrow 2%

National Average
$38,000

Entry-Level
up arrow 11%

Skills That Affect Medical / Health Claims Examiner Salaries

National Average
$38,000

Current Procedural Terminology (CPT) Coding
up arrow 1%

Medical Terminology
up arrow 2%


Medicaid & Medicare Billing
up arrow 5%

Claim Handling
up arrow 7%

Electronic Medical Records (EMR)
up arrow 10%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 26 votes.

Gender

Female
93 %
Male
7 %

Years of Experience

Less than 1 year
5%
1-4 years
27%
5-9 years
19%
10-19 years
31%
20 years or more
18%

Common Health Benefits

medical benefits
Medical: 84%
dental benefits
Dental: 74%
vision benefits
Vision: 64%
dental benefits
None: 14%
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