Most Health Claims Examiners in the United States are women. The workforce as a whole earns a median of approximately $17.60 per hour. Experience level and the particular city each impact pay for this group, with the former having the largest influence. Medical benefits are awarded to a large number, and a fair number earn dental coverage. Job satisfaction is high and work is enjoyable for most Health Claims Examiners. This report is based on answers to PayScale's salary questionnaire.

$29,560 - $56,097
(Median)
$30K
$41K
$56K
MEDIAN: $40,685
10%
50%
90%

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$12.56 - $22.75
(Median)
$13
$18
$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
$29,560 - $56,097  
   
Bonus
$0.00 - $2,923  
Profit Sharing
$2,500  
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).
)
$27,661 - $52,433  
Country: United States | Currency: USD | Updated: 28 Oct 2016 | Individuals Reporting: 55
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
$12.56 - $22.75  
   
Hourly Tips
$0.02  
Overtime
$17.22 - $32.28  
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 - $2,923  
   
Profit Sharing
$2,500  
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).
)
$27,661 - $52,433  
Country: United States | Currency: USD | Updated: 28 Oct 2016 | Individuals Reporting: 132
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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.

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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 $40K. Health Claims Examiners with one to two decades of relevant experience report an average salary of approximately $40K. More than 20 years of experience seem related to solid financial gains; veterans in this group report earning a median of $41K.

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Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 8%

Experienced
up arrow 4%

Mid-Career
up arrow 4%

National Average
$38,000

Entry-Level
up arrow 12%

Skills That Affect Medical / Health Claims Examiner Salaries

Medical Terminology
up arrow 2%

National Average
$38,000

Current Procedural Terminology (CPT) Coding
up arrow 2%


Medicaid & Medicare Billing
up arrow 6%

Claim Handling
up arrow 8%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 23 votes.

Gender

Female
91 %
Male
9 %

Years of Experience

Less than 1 year
5%
1-4 years
28%
5-9 years
17%
10-19 years
29%
20 years or more
21%

Common Health Benefits

medical benefits
Medical: 83%
dental benefits
Dental: 73%
medical benefits
Vision: 64%
dental benefits
None: 15%
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