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 $17.60 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.
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
- 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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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.