Medical / Health Claims Examiner Salary

Earnings for Health Claims Examiners in the United States come in at around $17.36 per hour on average. For the most part, Health Claims Examiners enjoy their work and report high levels of job satisfaction. Medical benefits are awarded to a strong majority, and more than half earn dental coverage. The vast majority of Health Claims Examiners (90 percent) who responded to the survey are women. Figures cited in this summary are based on replies to PayScale's salary questionnaire.

$29,932 - $54,302
(Median)
$30K
$40K
$54K
MEDIAN: $39,947
10%
50%
90%

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$12.17 - $22.69
(Median)
$12
$17
$23
MEDIAN: $17.00
10%
50%
90%

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National Salary Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$19K$38K$57K
Salary
$29,932 - $54,302  
   
Bonus
$0.00 - $2,983  
Profit Sharing
$101.74 - $3,931  
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).
)
$27,119 - $52,110  
Country: United States | Currency: USD | Updated: 20 Jun 2015 | Individuals Reporting: 104
National Hourly Rate Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$11$22$33
Hourly Rate
$12.17 - $22.69  
   
Overtime
$17.12 - $32.62  
National Annualized Data (?
XAll compensation data shown are gross, national 10th to 90th percentile ranges. Pay can vary greatly by location. To view local data, take the PayScale survey.
)
$0$22K$44K$66K
Bonus
$0.00 - $2,983  
   
Profit Sharing
$101.74 - $3,931  
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).
)
$27,119 - $52,110  
Country: United States | Currency: USD | Updated: 20 Jun 2015 | Individuals Reporting: 177
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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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Pay by Experience Level for Medical / Health Claims Examiner

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


Health Claims Examiners do not generally earn higher incomes from more experience in the field. The median compensation for relatively untried workers is $36K; in the five-to-10 year group, it's higher at around $38K. Health Claims Examiners with one to two decades of relevant experience report an average salary of approximately $40K. Health Claims Examiners who have stuck around for more than two decades see earnings that are only slightly higher than those of folks who have worked for 10 to 20 years; the more senior group makes around $41K on average.

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Experience Affects Medical / Health Claims Examiner Salaries

Late-Career
up arrow 7%

Experienced
up arrow 5%

National Average
$38,000

Mid-Career
up arrow 2%

Entry-Level
up arrow 7%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 51 votes.

Gender

Female
90 %
Male
10 %

Years of Experience

Less than 1 year
4%
1-4 years
29%
5-9 years
23%
10-19 years
23%
20 years or more
20%

Common Health Benefits

medical benefits Medical: 79% dental benefits Dental: 68%
vision benefits Vision: 60% employee benefits None: 18%
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