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Claims Examiner Ii Jobs (NOW HIRING)

MetroPlusHealth

Claims Examiner II

Manhattan, NY · On-site

$54K - $64K/yr

Audit work of assigned claims examiners to ensure accuracy. * Identify policies of common errors requiring retaining sessions * Assist with retraining sessions as directed. * Participate in quality ...

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Claims Examiner Ii information

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How much do claims examiner ii jobs pay per hour?

As of Aug 30, 2026, the average hourly pay for claims examiner ii 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 II do?

A Claims Examiner II is responsible for reviewing, analyzing, and processing insurance claims to determine their validity and ensure compliance with policy guidelines. They evaluate documentation, investigate discrepancies, and may communicate with claimants, providers, or other stakeholders to gather additional information. This position typically requires a solid understanding of claims procedures, relevant regulations, and industry standards. The 'II' designation usually indicates mid-level experience, meaning the examiner handles more complex or specialized claims than entry-level examiners.

What are the key skills and qualifications needed to thrive as a Claims Examiner II?

To thrive as a Claims Examiner II, you need a solid understanding of insurance policies, claims processing procedures, and relevant regulations, often supported by prior experience in claims or a related field. Familiarity with claims management software, document imaging systems, and knowledge of industry certifications such as AIC (Associate in Claims) are typically expected. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating claims and collaborating with stakeholders. These competencies ensure accurate, timely claim resolutions, minimize errors, and support customer satisfaction and regulatory compliance.

How does a Claims Examiner II typically collaborate with other departments during the claims review process?

As a Claims Examiner II, you will routinely interact with various departments such as customer service, underwriting, and legal teams to ensure claims are processed accurately and in compliance with company policies. Collaboration is critical when clarifying policy details, investigating complex cases, or resolving discrepancies. You may participate in cross-functional meetings, share updates on claim status, and seek input on unusual or escalated cases. This teamwork not only helps maintain efficiency but also provides valuable insights for professional growth and a comprehensive understanding of the claims lifecycle.

What is the difference between Claims Examiner Ii vs Claims Processor?

CriteriaClaims Examiner IiClaims Processor
Required credentialsHigh school diploma or equivalent; some roles may prefer insurance-related certificationsHigh school diploma or equivalent; less emphasis on certifications
Work environmentOffice setting, analyzing claims, reviewing documentationOffice or administrative setting, processing claims data
Employer and industry usageInsurance companies, government agenciesInsurance companies, third-party administrators
Common search and comparison intentUnderstanding role differences, job requirements, career pathJob duties, qualifications, and how it compares to similar roles

The Claims Examiner II typically reviews and approves insurance claims, requiring analytical skills and some certifications. In contrast, Claims Processors focus on data entry and processing claims without extensive review responsibilities. Both roles are essential in insurance operations but differ in complexity and scope.

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 $65,000, depending on experience, location, and employer. Entry-level positions may start lower, while experienced examiners or those with specialized skills can earn higher wages, often supplemented with benefits and opportunities for advancement.

Is being a claims examiner hard?

Claims Examiner II roles involve reviewing insurance claims, which requires attention to detail, strong analytical skills, and knowledge of policies. The job can be challenging due to the need for accuracy and understanding complex cases, but it is manageable with experience and training. Familiarity with claims processing software and certifications can also help ease the workload.
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What states have the most Claims Examiner Ii jobs?

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What job categories do people searching Claims Examiner Ii jobs look for?

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

Claims Examiner Ii jobs near you
Infographic showing various Claims Examiner Ii 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 II

Fairfield, CA • On-site

Partnership HealthPlan of California
Insurance Services • 501 - 1,000 employees
Learn more about Partnership HealthPlan of Californiaexternal

$31.45 - $37.74/hr

Other

Re-posted 17 days ago

Job description

Overview
To review, research, and resolve claims for all Medi-Cal claim types within established production
and quality standards, including manual processing. Completes and processes claims and claims
worksheets. Creates appropriate documentation that reflects the actions taken and status of the
claim. Generates provider communication, such as letters, as necessary. Routes and tracks
claims requiring review by other staff and departments, and processes when possible. Claims
Examiner II is distinguished from Claims Examiner I by a higher level of autonomy and experience,
as well as an ability to process a wider range of claim types.
Responsibilities
  • ESSENTIAL DUTIES AND RESPONSIBILITIES
    - Reviews, researches, and resolves pended claims for Medi-Cal types: medical, ancillary,
    long term care, CHDP, encounter data, other coverage, and batch claims within established
    production and quality standards. Completes claims from the Batch Error Report and Batch
    Pass Report.
    - Routes claims to appropriate Partnership departments and internal staff for additional review.
    Follows up and completes claims once response to request has been received.
    - Follows established Partnership policies and procedures, Partnership Claims Operating Instruction
    Memorandums, State of California Medi-Cal Provider Manual guidelines, Title 22
    regulations, and CMS guidelines when resolving pended claims.
    - Generates claims correspondence as needed.
    - Records daily production statistics and related activities on appropriate reports. Turns in all
    logs and reports to the Medi-Cal Claims Supervisor.
    - Reviews all work audits in a timely manner and submits any adjustments and corrections
    within the allotted time frame.
    - Supports Claims Department's needs for resolving all pended claim types.
    - Participates in special projects and assignments as required.
    - Identifies and reports trends of pending claims that are increasing or processes that appear
    dated.
    - Recognizes and gives feedback to management on procedure changes that would result in
    more efficient operations.
    - Other duties as assigned.

Qualifications
Education and Experience
High school diploma or equivalent; minimum one (1) year in Medi-Cal
billing and/or claims examining experience in an automated
environment
Special Skills, Licenses and Certifications
Effective written and oral communication skills. Good organization skills.
Knowledge of claims processing and/or Medi-Cal billing, CPT, and ICD10 knowledge preferred.
Performance Based Competencies
Ability to effectively exercise good judgement within scope of authority
and handle sensitive issues with tact and diplomacy. Ability to stay
focused on repetitive work and meet production and quality standards.
Ability to accurately complete tasks within established timelines.
Consistently meets production standards without compromising quality
on all tasks.
Work Environment And Physical Demands
Ability to use a microcomputer keyboard. More than 95% of work time
is spent in front of a computer monitor. When required, ability to move,
carry, or lift objects of varying size, weighing up to 5 lbs.
All HealthPlan employees are expected to:
  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.

HIRING RANGE:
$ 31.4512- $ 37.74
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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