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Claims Examiner Jobs in Rochester, NY (NOW HIRING)

Complex Claims Specialist

Rochester, NY · On-site

$127K - $148K/yr

General Summary: A Complex Claims Specialist will possess experience in handling complex medical liability claims, while demonstrating a strong client service focus. Essential Duties ...

To analyze and process low to mid-level auto and transportation claims. ESSENTIAL RESPONSIBLITIES MAY INCLUDE * Processes auto property damage and lower level injury claims; assesses damage, makes ...

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Claims Assistant SSL

Canandaigua, NY · On-site

$17.68 - $21.87/hr

Claims Assistant The Claims Assistant is an administrative support position within the Standard Security claims department. Duties and Responsibilities: * Accurately file claimant specific ...

Claims Assistant SSL

Canandaigua, NY · Hybrid

$17.68 - $21.87/hr

Job Responsibilities and Requirements The Claims Assistant is an administrative support position within the Standard Security claims department. Duties and Responsibilities: * Accurately file ...

As an auto damage claims adjuster , you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end. Managing your ...

As an auto damage claims adjuster , you'll serve as Progressive's point of contact with customers - directing and making decisions regarding the repair process from beginning to end. Managing your ...

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Claims Examiner information

See Rochester, NY salary details

$15

$29

$45

How much do claims examiner jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for claims examiner in Rochester, NY is $29.01, according to ZipRecruiter salary data. Most workers in this role earn between $22.07 and $34.62 per hour, depending on experience, location, and employer.

What is a claims examiner?

A claims examiner evaluates claim files that have been submitted by an insurance adjuster. They decide whether to authorize or deny payments and refer suspicious or complicated claims to insurance investigators. This job is a risk management position. In health insurance, examiners may have to decide if medical procedures are worth the patient’s prognosis, if someone's cause of death warrants incidental fees, or if witness interviews waive the insurance company’s liability.

What does a claims examiner do?

A Claims Examiner is responsible for reviewing insurance claims to determine their validity and whether they should be approved or denied. They carefully examine claim forms, supporting documents, and sometimes conduct interviews to gather additional information. Claims Examiners ensure that claims comply with policy terms and legal requirements, and may calculate the amount to be paid out. Their work helps prevent fraudulent claims and ensures fair processing for all parties involved.

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

To thrive as a Claims Examiner, you need strong analytical skills, attention to detail, and a background in insurance, finance, or a related field, often supported by relevant certifications or a degree. Familiarity with claims management software, regulatory compliance systems, and industry-specific databases is typically required. Excellent communication, problem-solving abilities, and good judgment help you stand out in this position. These skills and qualities are crucial for ensuring accurate claim evaluations, minimizing risk, and maintaining customer trust.

What are some common challenges faced by claims examiners, and how can they be managed effectively?

Claims Examiners often encounter challenges such as reviewing complex or incomplete documentation, managing a high volume of claims, and balancing the need for accuracy with efficiency. Effective organization, strong attention to detail, and clear communication with claimants and other team members are essential for overcoming these obstacles. Additionally, staying current with industry regulations and using claims management software can help streamline the process and reduce errors.

What is the difference between Claims Examiner vs Claims Processor?

AspectClaims ExaminerClaims Processor
Required credentialsHigh school diploma or equivalent; often some insurance or claims experienceHigh school diploma or equivalent; may have basic insurance knowledge
Work environmentOffice setting, reviewing claims, making determinationsOffice setting, processing claims data, data entry
Employer and industry usageInsurance companies, government agenciesInsurance companies, third-party administrators
Common search intentUnderstanding roles, career differences, job requirementsEntry-level position, processing claims, job duties

Claims Examiners review insurance claims to determine coverage and approve or deny payments, requiring analytical skills and some insurance knowledge. Claims Processors handle the data entry and processing of claims, focusing on accuracy and efficiency. While both roles work in insurance settings and may require similar credentials, Claims Examiners have more decision-making responsibilities, whereas Claims Processors focus on data handling.

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 examiners review insurance claims to determine coverage and payment, which can involve detailed analysis and attention to accuracy. The job often requires strong organizational skills, knowledge of policies, and sometimes certification, but the difficulty varies based on experience and the complexity of claims handled.

What are the most commonly searched types of Claims Examiner jobs in Rochester, NY?

The most popular types of Claims Examiner jobs in Rochester, NY are:

What are popular job titles related to Claims Examiner jobs in Rochester, NY?

For Claims Examiner jobs in Rochester, NY, the most frequently searched job titles are:

What job categories do people searching Claims Examiner jobs in Rochester, NY look for?

The top searched job categories for Claims Examiner jobs in Rochester, NY are:

What cities near Rochester, NY are hiring for Claims Examiner jobs?

Cities near Rochester, NY with the most Claims Examiner job openings:

Infographic showing various Claims Examiner job openings in Rochester, NY as of August 2026, with employment types broken down into 1% Internship, 84% Full Time, 12% Part Time, and 3% Contract. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $60,341 per year, or $29 per hour.

$48K - $55K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 19 days ago


Job description

Responsibilities:
To provide Absence case management and claim adjudications, based on medical documentation and the applicable Disability/FMLA/Paid Family Leave interpretation, including determining benefits due and making timely payments and adjustments.
Review and analyze the claim nuances, eligibility review, and type of claims (intermittent or continuous)
Review and analyze medical information (i.e. attending physician reports, medical records such as diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined.
Approval or denial on FMLA claims as per Insurance carrier, and employers guidelines
Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to US paid family law regulations.
Review claims for Not in good order cases, and work on securing missing documentations including employee, physician, or employer outreach.
Communicates clearly with the claimants and clients to set expectations on all aspects of claims process either by phone and/or written correspondence.
Reviews client critical deliverables, manages the overall workload, and second-level process escalation.
Determines benefits due, makes timely claims payments/approvals and adjustments for Workers Compensation, State Short Term Disability, and other disability offsets.
Refers cases as appropriate to team lead and clinical case management
Responsible for managing the day-to-day workload and first-level process escalation, and reviews processes for accuracy and timeliness where applicable in case of peer reviews.
Provide ideas to management on continuous improvement and service level management
Performs other duties or participates in special projects as assigned
Requirements:
1+ year of Disability/FMLA/PFL claims or insurance claims experience
Experience working with FINEOS
Working knowledge of medical terminology and documents, including APS, Diagnostic Tests, Imaging Tests reports
Knowledge of disability insurance claims, benefits administration, offsets and deductions, disability duration and medical management practices mandatory
Excellent oral and written communication, including presentation skills
Strong Analytical, decision making, problem solving, and people management skills
Computer experience with keyboarding skills and proficiency in using software applications and packages including MS Office (Excel, Word, PPT)
Willingness to embrace change in a fast paced work environment
A strong desire to continuously learn and improve
Identify escalated cases and work with Team Leader to develop a plan to address key issues.
TCS Employee Benefits Summary:
• Discretionary Annual Incentive.
• Comprehensive Medical Coverage: Medical & Health, Dental & Vision, Disability Planning & Insurance, Pet Insurance Plans.
• Family Support: Maternal & Parental Leaves.
• Insurance Options: Auto & Home Insurance, Identity Theft Protection.
• Convenience & Professional Growth: Commuter Benefits & Certification & Training Reimbursement.
• Time Off: Vacation, Time Off, Sick Leave & Holidays.
• Legal & Financial Assistance: Legal Assistance, 401K Plan, Performance Bonus, College Fund, Student Loan Refinancing.
Salary Ran ge: $48,000 - $55,000 per year