ZipRecruiter

Log In

1

Claims Examiner Jobs (NOW HIRING)

Texas Children's Hospital

Claims Examiner

Bellaire, TX · On-site

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 ...

Sigma Systems, Inc.

Claims Examiner

Irving, TX · On-site

9151476 - Claims Examiner Irving, TX 3 Months contract Sigma Inc. is currently looking for a Claims Examiner in Irving, TX. Shift Timings: Work Schedule: 5 Days - 8 Hours Summary: * The Claims ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and ...

Firstsource

Claims Examiner

$17/hr

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department: Health Plan and Healthcare Services Reporting to: Team Lead/Supervisor - Operations Pay Rate: $17/hr ...

University Health

Claims Examiner

San Antonio, TX

We are looking for an experienced Claims Examiner for our Claims department with Community First Health Plans ! POSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital ...

Firstsource

Claims Examiner

$17/hr

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department: Health Plan and Healthcare Services Reporting to: Team Lead/Supervisor - Operations Pay Rate: $17/hr ...

Trawick International Inc

Claims Examiner

Miami, FL · On-site

Claims Examiner Department: Claims Reports to: Claims Supervisor Date: Job Summary Are you looking for a career where you can apply your experience and passion for providing world class service to ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

Job Type Full-time Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and Independent ...

Firstsource

Claims Examiner

Louisville, KY · On-site

$17/hr

Claims Examiner Job Type: Full Time FLSA Status: Non-Exempt/Hourly Grade: H Function/Department: Health Plan and Healthcare Services Reporting to: Team Lead/Supervisor - Operations Pay Rate: $17/hr ...

Aston Carter

Claims Examiner

Naperville, IL · On-site

$20/hr

Claims Examiner This role entails the review, investigation, evaluation, and determination of eligibility for claims. The Claims Examiner negotiates the resolution of claims in compliance with all ...

Lowe's

Senior Claims Examiner

Mooresville, NC

... Claims Examiners by integrating Lowe's culture, team training, and jurisdiction-specific training into the on-boarding process Conducts investigations of claims by interviewing claimants and ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ The Medical Claims Examiner needs experience with ICD-10, Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), In-Patient ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ The responsibilities of the Medical Claims Examiner consist of processing claims data and adjudicating medical and inpatient claims received from all provider ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Medical Claims Examiner, Tucson, AZ Under general supervision from the Director of Operations, the responsibility of Medical Claims Examiner consists of processing claim data and adjudicating medical ...

Richmond National

Claims Examiner

Glen Allen, VA · On-site

$65K - $85K/yr

Claims Examiner Location: Full time in-office, Richmond, VA 23233 We are seeking a highly motivated Claims Examiner to join our team. The ideal candidate will be responsible for investigating ...

Gallagher

Claims Examiner

Oakland, CA · Remote

The Claims Examiner is responsible for liability claims and property damage claims to their conclusion in the most cost-effective way possible for the client. In addition, the Claims Examiner will be ...

previous pagenext page

Showing results 21-40

All JobsClaims Examiner Jobs

Claims Examiner information

See salary details

$15

$29

$45

How much do claims examiner jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for claims examiner 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.

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.

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.

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 do I need to be a claims examiner?

To become a claims examiner, candidates typically need a high school diploma or equivalent, with some roles preferring an associate's or bachelor's degree in fields like insurance, finance, or healthcare. Strong analytical skills, attention to detail, and knowledge of insurance policies and claims processing are essential, along with proficiency in computer software and sometimes relevant certifications such as the Certified Claims Professional (CCP).

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 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 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.

More about Claims Examiner jobs
What cities are hiring for Claims Examiner jobs? Cities with the most Claims Examiner job openings:
What are the most commonly searched types of Claims Examiner jobs? The most popular types of Claims Examiner jobs are:
Who are the top companies hiring for Claims Examiner jobs? The top employers for Claims Examiner jobs are:
What states have the most Claims Examiner jobs? States with the most job openings for Claims Examiner jobs include:
What job categories do people searching Claims Examiner jobs look for? The top searched job categories for Claims Examiner jobs are:
What are popular job titles related to Claims Examiner jobs? For Claims Examiner jobs, the most frequently searched job titles are:
Claims Examiner jobs near you
Infographic showing various Claims Examiner job openings in the United States as of August 2026, with employment types broken down into 1% Internship, 89% Full Time, 8% Part Time, and 2% Contract. Highlights an 84% Physical, 5% Hybrid, and 11% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Examiner/Senior Claims Examiner

Berkley

Walnut Creek, CA • On-site

$65K - $115K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 days ago

Job description

Company Details
Preferred Employers Insurance, A Berkley Company specializes in providing workers' compensation insurance to California business owners. The company serves three major Product/Client Segments: Small Business, Mid-Larger Businesses and Group Association Members (Programs). The company's distribution partners (agents & brokers) number just under 400 locations throughout the state. Preferred serves thousands of policyholders and provides medical claims handling and claims management as needed to care for injured workers. The company is rated A+ Superior by industry-rating organization, AM Best & Company.
Company URL: https://www.peiwc.com
The company is an equal opportunity employer.
Responsibilities
We are seeking Workers' Compensation Claims Examiners and Senior Claims Examiners to join our team. In these roles, you will be responsible for the analysis and management of moderate to complex workers' compensation claims, including reviewing, investigating, and making determinations around coverage, compensability, and claim appropriateness. You will ensure all claims are processed and documented in compliance with company standards, industry best practices, and applicable legislative requirements while acting in a fiduciary capacity on behalf of policyholders.
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with the rules, regulations, and statutes of the Workers' Compensation Appeals Board (WCAB) and the State of California. Success in this role requires strong judgment, consistent performance, and a high level of competency in negotiating settlements, managing subrogation, and delivering sound, compliant outcomes.
Key functions include but are not limited to:
  • Analyzes and processes workers' compensation claims by investigating and gathering information to determine the exposure on the claim.
  • Negotiates settlement of claims up to designated authority level and makes claims payments.
  • Processes complex or technically difficult claims.
  • Calculates and assigns timely and appropriate reserves to claims and continues to manage reserve adequacy throughout the life of the claim.
  • Calculates and pays benefits due; approves all claim payments; and settles claims within designated authority level.
  • Develops and manages claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution.
  • Prepares necessary state filings within statutory limits.
  • Actively manages the litigation process; ensures timely and cost-effective claims resolution.
  • Coordinates vendor referrals for additional investigation and/or litigation management.
  • Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims.
  • Manages claim recoveries of all types, including but not limited to subrogation, Second Injury Fund recoveries, and Social Security offsets.
  • Reports claims to the excess carrier, responds to requests of directions in a professional and timely manner.
  • Frequently communicates with all appropriate parties involved with the claim.
  • Refers cases as appropriate to management.
  • Maintains professional client relationships.
  • Actively executes appropriate claims activities to ensure consistent delivery of quality claims service.

Qualifications
  • 2+ years claims management experience.
  • Professional certification as applicable to workers' compensation required
  • WCCP Preferred
  • In depth knowledge of appropriate insurance principles and laws for workers' compensation.
  • Strong written and verbal communication skills.
  • Strong organizational skills.
  • Strong negotiation skills
  • Strong analytical and interpretive skills.
  • PC literate.
  • Professional certification as applicable to workers' compensation required.

Additional Company Details
We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees which for this role include:
• Base Salary Range: $65,000 - $115,000 annually
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Sponsorship Details
Sponsorship not Offered for this Role

Apply