Medical / Health Claims Examiner Salary

An average Health Claims Examiner in the United States can expect to take home roughly $17.13 per hour. The vast majority of Health Claims Examiners (90 percent) who responded to the survey are women. Job satisfaction is high and work is enjoyable for most Health Claims Examiners. Medical benefits are awarded to a fair number, and a majority earn dental coverage.

$29,621 - $54,302

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$12.17 - $22.69

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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
$29,621 - $54,302  
   
Bonus
$0.00 - $2,987  
Profit Sharing
$100.00 - $4,000  
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).
)
$27,061 - $52,073  
Country: United States | Currency: USD | Updated: 18 Jul 2015 | Individuals Reporting: 104
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
$12.17 - $22.69  
   
Overtime
$17.00 - $32.70  
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 - $2,987  
   
Profit Sharing
$100.00 - $4,000  
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).
)
$27,061 - $52,073  
Country: United States | Currency: USD | Updated: 18 Jul 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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Professional skills reported by Health Claims Examiners are few in number. Medical Coding and Claim Handling are considered valuable skills and can increase employee pay. At the other end of the pay range are skills like Claim Handling and Medical Coding.

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 with a lot of experience do not necessarily enjoy more money. Relatively untried employees who have less than five years' experience have a median salary of $35K. Those who have been around for five to 10 years can expect to take home more — $38K on average. The average pay reported by folks with 10 to 20 years of experience is around $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 8%

Experienced
up arrow 5%

National Average
$38,000

Mid-Career
up arrow 2%

Entry-Level
up arrow 8%

Skills That Affect Medical / Health Claims Examiner Salaries

National Average
$38,000


Claim Handling
up arrow 11%

Job Satisfaction

Extremely satisfied
Rated 5 out of 5
based on 49 votes.

Gender

Female
90 %
Male
10 %

Years of Experience

Less than 1 year
4%
1-4 years
28%
5-9 years
23%
10-19 years
23%
20 years or more
21%

Common Health Benefits

medical benefits Medical: 79% dental benefits Dental: 69%
vision benefits Vision: 61% employee benefits None: 19%
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