Medical / Health Claims Examiner Salary

Most Health Claims Examiners in the United States are women. The workforce as a whole earns a median of approximately $17.17 per hour. Experience level and the particular city each impact pay for this group, with the former having the largest influence. For the most part, Health Claims Examiners enjoy their work and report high levels of job satisfaction. A fair number enjoy medical while a majority get dental coverage. Vision coverage is also available to more than half. This overview is based on answers to PayScale's salary questionnaire.

$29,993 - $54,577
(Median)
$30K
$41K
$55K
MEDIAN: $40,593
10%
50%
90%

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$12.08 - $22.75
(Median)
$12
$17
$23
MEDIAN: $17.00
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$19K$38K$57K
Salary
$29,993 - $54,577  
   
Bonus
$0.00 - $3,009  
Profit Sharing
$1,600  
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).
)
$26,934 - $52,435  
Country: United States | Currency: USD | Updated: 12 Jan 2016 | Individuals Reporting: 106
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$11$22$33
Hourly Rate
$12.08 - $22.75  
   
Hourly Tips
$0.64  
Overtime
$14.68 - $31.91  
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$22K$44K$66K
Bonus
$0.00 - $3,009  
   
Profit Sharing
$1,600  
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).
)
$26,934 - $52,435  
Country: United States | Currency: USD | Updated: 12 Jan 2016 | Individuals Reporting: 185
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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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Job skills reported by Health Claims Examiners are limited. Most notably, skills in Claim Handling, Medical Coding, Medical Terminology, and Current Procedural Terminology (CPT) Coding are correlated to pay that is above average. At the other end of the pay range are skills like Current Procedural Terminology Coding, Medical Terminology, and Medical Coding. Aptitude in Medical Coding tends to also indicate an understanding of Medical Terminology.

Pay by Experience Level for Medical / Health Claims Examiner

Median of all compensation (including tips, bonus, and overtime) by years of experience.


For many Health Claims Examiners, extensive experience does not lead to significantly more money. Salaries for the relatively untried average out to around $35K, but survey participants with five to 10 years of experience earn a significantly higher median of $38K. Health Claims Examiners who work for 10 to 20 years in their occupation tend to earn about $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.

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Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 6%

Experienced
up arrow 4%

National Average
$38,000

Mid-Career
up arrow 1%

Entry-Level
up arrow 9%

Skills That Affect Medical / Health Claims Examiner Salaries

Claim Handling
up arrow 4%

National Average
$38,000

Medical Coding
up arrow 4%

Medical Terminology
up arrow 8%

Current Procedural Terminology (CPT) Coding
up arrow 13%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 43 votes.

Gender

Female
91 %
Male
9 %

Years of Experience

Less than 1 year
4%
1-4 years
29%
5-9 years
21%
10-19 years
24%
20 years or more
22%

Common Health Benefits

medical benefits
Medical: 79%
dental benefits
Dental: 69%
medical benefits
Vision: 60%
dental benefits
None: 18%
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