Medical / Health Claims Examiner Hourly Rate

Job Satisfaction

Extremely satisfied Image
Extremely satisfied
Rated 5 out of 5 based on 20 Medical / Health Claims Examiner votes.
national salary data
National Pay Data
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
$12.44 - $23.53  
   
Overtime
$17.22 - $34.96  
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
$-0.49 - $2,447  
   
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).
)
$27,614 - $53,488  
Country: United States | Currency: USD | Updated: 4 Feb 2017 | Individuals Reporting: 176

Medical / Health Claims Examiner Job Listings

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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.

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.

Key Stats

Gender

Female
93 %
Male
8 %
Hourly Rate
$12 - $20
Hourly Rate
$15 - $16

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 26 votes.
Less than 1 year
6%
1-4 years
27%
5-9 years
18%
10-19 years
32%
20 years or more
16%

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