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Claims Examiner 1 Jobs (NOW HIRING)

Texas Children's Hospital

Claims Examiner

Bellaire, TX · On-site

Diploma or GED • Required 1 year claims examination experience About Us Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for ...

Texas Children's Hospital

Claims Examiner

Bellaire, TX · On-site

Diploma or GED • Required 1 year claims examination experience About Us Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ The responsibilities of the Medical Claims Examiner consist of ... one month of hire, complete new-employee orientation. - Complete and provide all training as ...

Spooner Incorporated

Claims Examiner

Westlake, OH · On-site

Join the Spooner Family as a Workers' Compensation Claims Examiner! At Spooner Incorporated , we're ... At least 1 year of workers' compensation claims experience * Strong communication and ...

Lowe's

Senior Claims Examiner

Mooresville, NC

... claims examiners on a team, focusing on bodily injury or property damage in a particular ... Lowe's employs approximately 300,000 associates and operates over 1,750 home improvement stores ...

Insperity

Medical Claims Examiner

Los Angeles, CA · On-site +1

$24 - $30/hr

General information Client / Corporate Client Work Mode Hybrid Name Medical Claims Examiner Job ID ... Apply now and help us transform lives-one claim at a time! We are an equal opportunity employer ...

Peyton Resource Group

Claims Examiner

San Antonio, TX · On-site

Position Summary We are seeking a detail-oriented Claims Examiner & Support Specialist I to support ... Minimum 1 year of call center or customer service experience preferred. Previous healthcare claims ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... At least 1-2 years of experience working closely with healthcare claims or in a claims processing ...

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Claims Examiner 1 information

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$15

$29

$45

How much do claims examiner 1 jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for claims examiner 1 in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What does a claims examiner 1 do?

A Claims Examiner 1 is responsible for reviewing insurance claims to determine their validity and ensure they comply with policy terms. They analyze documentation, investigate discrepancies, and may communicate with policyholders or other parties to gather necessary information. Their work helps prevent fraud and ensures that claim payments are accurate and justified. Typically, a Claims Examiner 1 handles straightforward cases and refers complex claims to more senior examiners.

What are the key skills and qualifications needed to thrive as a claims examiner 1, and why are they important?

To thrive as a Claims Examiner 1, you need a solid understanding of insurance policies, claims processing procedures, and attention to detail, often supported by a high school diploma or associate degree. Familiarity with claims management software, industry regulations, and basic office applications is typically required. Strong analytical skills, effective communication, and organizational abilities help resolve claims accurately and efficiently. These skills are crucial for ensuring claims are processed fairly, minimizing errors, and maintaining customer satisfaction.

What are some common challenges new claims examiners 1 might face, and how can they overcome them?

New Claims Examiners 1 often face challenges such as interpreting complex policy language, managing a high volume of claims, and balancing accuracy with efficiency. To overcome these challenges, it's helpful to familiarize yourself thoroughly with the company's policies and procedures, seek guidance from experienced colleagues, and utilize available training resources. Building strong organizational skills and maintaining clear communication with claimants and other departments can also help ensure a smoother workflow and reduce errors. Over time, these strategies contribute to increased confidence and proficiency in handling diverse claims.

What is the difference between Claims Examiner 1 vs Claims Examiner 2?

AspectClaims Examiner 1Claims Examiner 2
Required CredentialsHigh school diploma or equivalent; some roles may require certificationHigh school diploma or equivalent; some roles may require certification
Work EnvironmentOffice setting, reviewing insurance claimsOffice setting, reviewing more complex claims or higher volume
Employer & Industry UsageInsurance companies, government agenciesInsurance companies, government agencies, third-party administrators
Common Search & ComparisonYesYes

The main difference between Claims Examiner 1 and Claims Examiner 2 lies in experience level and complexity of claims handled. Claims Examiner 2 typically manages more complex cases and may require additional certifications or experience. Both roles operate in similar environments within insurance and government sectors, but Claims Examiner 2 often involves higher responsibilities and expertise.

How much do claims examiners make in the US?

Claims examiners in the US typically earn a median annual salary of around $45,000 to $55,000, with entry-level positions starting lower and experienced examiners earning higher wages. Salaries can vary based on location, experience, and the employer, and some roles may require knowledge of claims processing software and certification.

Is claims processing a stressful job?

Claims Examiner 1 roles can be stressful due to the need for accuracy, attention to detail, and meeting deadlines when reviewing and processing insurance claims. The job often involves handling complex cases and dealing with claimants' concerns, which can contribute to work-related stress, especially during high-volume periods or when resolving disputes.
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What job categories do people searching Claims Examiner 1 jobs look for?

The top searched job categories for Claims Examiner 1 jobs are:

Claims Examiner 1 jobs near you
Infographic showing various Claims Examiner 1 job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 87% Full Time, 10% Part Time, and 2% Contract. Highlights an 82% Physical, 5% Hybrid, and 13% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Examiner

Texas Children's Hospital

Bellaire, TX

Full-time

Re-posted 26 days ago

Texas Children's Hospital rating

8.3

Company rating: 8.3 out of 10

Based on 177 frontline employees who took The Breakroom Quiz

86th of 1,064 rated hospitals

Job description

We are looking for a Claims Examiner, someone who's ready to grow with our company. In this position, you will process and adjudicate claims received for reimbursement to Providers based on extensive review, research, and a detailed format of claim processing procedures. 
Think you've got what it takes? 
Job Duties & Responsibilities 
    Adjudicate claims received into processing system. 
    Thoroughly reviews, investigates, and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time. 
    Examiners should process at least 14 claims per hour, or 98 claims per day. 
    Conducts review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days. 
    Macess requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements. 
    The claims are processed accurately as defined by standard guidelines. 
    The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports. 
    The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review. 
    The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time. 
    Clear concise documentation/notes must be entered for each claim reviewed, which provides a historical reference of how the claim was processed at the time of adjudication. 
    Complete special projects as requested. 
Skills & Requirements 
    Required H.S. Diploma or GED 
    Required 1 year claims examination experience 
 

Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.

To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.

Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

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