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Complex Claims Examiner Jobs (NOW HIRING)

Americo

Complex Claims Examiner I

Kansas City, MO · On-site

Overview We are currently looking for an experienced Complex Claims Examiner I to join our growing Claims team! Key Responsibilities * Reviewing and investigating the company's contractual liability ...

ImageNetLLC

Claims Examiner - Remote

Tampa, FL · Remote

Salary: Claims Examiner - Remote Job Type: Full-time Work Setup: This is a fully remote position ... Handle more complex claims with multiple services, providers Experience: * At least 1-2 years of ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... Handle more complex claims with multiple services, providers Experience: * At least 1-2 years of ...

ImagenetLLC

Claims Examiner - Remote

Tampa, FL · Remote

Claims Examiner - Remote Job Type : Full-time Work Setup: This is a fully remote position Work ... Handle more complex claims with multiple services, providers Experience: * At least 1-2 years of ...

Imagenet

Claims Examiner - Remote

Tampa, FL · On-site +1

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... Handle more complex claims with multiple services, providers Experience: * At least 1-2 years of ...

Venbrook

Claims Examiner

Los Angeles, CA · On-site

Claims Examiner, Public Entity DEPARTMENT: Claims Services LOCATION: Onsite - Downtown LA COMPANY ... Demonstrates strong listening skills and the ability to convey complex claims information in a ...

Venbrook

Claims Examiner

Los Angeles, CA · On-site

Claims Examiner, Public Entity DEPARTMENT: Claims Services LOCATION: Onsite - Downtown LA COMPANY ... Demonstrates strong listening skills and the ability to convey complex claims information in a ...

Tristar Insurance

Claims Examiner III (Hybrid)

Fresno, CA · On-site

$35 - $43/hr

... Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the ... Effectively manages a caseload of 150 to 180 workers' compensation files, including complex claims.

Tristar Insurance

Claims Examiner III (Hybrid)

Fresno, CA · Hybrid

$35 - $43/hr

... Examiners, and other TRISTAR staff in the office; therefore consistently being at work in the ... Effectively manages a caseload of 150 to 180 workers' compensation files, including complex claims.

Tmhcc

Associate Bond Claims Examiner

Los Angeles, CA

$29.44 - $40.46/hr

Claims Examiner TokioMarine HCC - Surety Group, a member of theTokioMarine Group of Companies, has ... and complex claims. Experience & Education Qualifications * Up to two years of relevant ...

Next Step Systems

Claims Examiner

Tucson, AZ · On-site

Claims Examiner, Tucson, AZ Under general supervision from the Director of Operations, the ... learn complex business processes and understand the underlying transactional systems. - Strong ...

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Complex Claims Examiner information

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How much do complex claims examiner jobs pay per hour?

As of Aug 4, 2026, the average hourly pay for complex 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.

What are some typical challenges a complex claims examiner faces when handling intricate cases?

Complex Claims Examiners often deal with multifaceted cases that require in-depth analysis, thorough documentation review, and coordination with multiple stakeholders such as legal teams, medical professionals, and policyholders. One common challenge is interpreting ambiguous policy language and making fair determinations while remaining compliant with regulations. Additionally, managing high caseloads and tight deadlines can be demanding, so strong organizational and communication skills are essential. Successfully navigating these challenges helps build expertise and prepares examiners for future advancement within claims management.

How much do complex claims examiners make in the US?

Complex claims examiners in the US typically earn a median annual salary of around $70,000 to $85,000, depending on experience, location, and employer. They often require strong analytical skills and knowledge of insurance policies, with some positions offering additional compensation for certifications or specialized expertise.

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

To thrive as a Complex Claims Examiner, you need advanced knowledge of insurance policies, legal regulations, and claims investigation, typically supported by a bachelor's degree and relevant industry experience. Familiarity with claims management software, data analysis tools, and sometimes certifications like AIC (Associate in Claims) are often required. Strong analytical thinking, attention to detail, and effective communication are standout soft skills in this role. These skills ensure accurate claim assessments, mitigate risk for the organization, and foster trust with clients and stakeholders.

Is being a complex claims examiner hard?

Complex claims examiners analyze and evaluate detailed insurance claims, which can be challenging due to the need for strong attention to detail, analytical skills, and understanding of policy language. The role often requires critical thinking, problem-solving, and sometimes working under tight deadlines, making it a demanding but manageable profession for those with relevant skills and experience.

What is the difference between Complex Claims Examiner vs Claims Adjuster?

AspectComplex Claims ExaminerClaims Adjuster
Required CredentialsInsurance license, sometimes certifications like CPCU or AICInsurance license, often similar certifications
Work EnvironmentInsurance companies, claims departmentsInsurance companies, independent agencies, or third-party administrators
Job FocusEvaluating complex or high-value claims, detailed analysisInvestigating, negotiating, and settling claims

The Complex Claims Examiner specializes in reviewing and analyzing complex or high-value insurance claims, often requiring detailed assessments and specialized knowledge. Claims Adjusters handle a broader range of claims, including simpler cases, focusing on investigation and settlement. While both roles require insurance licensing and similar certifications, the Complex Claims Examiner typically deals with more intricate cases within insurance companies' claims departments.

What is a complex claims examiner?

Complex Claims Examiners are professionals who review, analyze, and process insurance claims that involve complicated circumstances, high-value losses, or ambiguous policy interpretations. They investigate claims by gathering evidence, interviewing involved parties, and consulting policy documents to determine the validity and extent of the insurer’s liability. These examiners work closely with legal teams, medical experts, or other specialists as needed to resolve claims efficiently and fairly. Their role is crucial in ensuring that claims are handled accurately while minimizing fraud and ensuring compliance with regulations.
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What job categories do people searching Complex Claims Examiner jobs look for? The top searched job categories for Complex Claims Examiner jobs are:
Complex Claims Examiner jobs near you
Infographic showing various Complex Claims Examiner job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Complex Claims Examiner I

Americo Life, Inc.

Kansas City, MO

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 20 days ago

Job description

Overview

We are currently looking for an experienced Complex Claims Examiner I to join our growing Claims team!

Key Responsibilities

  • Reviewing and investigating the companys contractual liability under contestable life claims
  • Processing contestable life claims
  • Preparing prompt, comprehensive and accurate correspondence
  • Servicing beneficiaries and other callers
  • Managing and effectively prioritizing multiple case files
  • Reviewing medical records and policy files to determine the appropriate course of action and making recommendations based on facts/issues presented, contractual obligations, laws and regulations

Experience and Qualifications

  • Good understanding or ability to learn in house systems (Workflow/Imaging System, Life Insurance Policy Administration systems, Microsoft Office applications)
  • Extensive knowledge of life and disability insurance, contestable claims, contracts and medical terminology
  • Well organized, detail oriented, uses time efficiently and is able to work independently and think critically
  • Analytical skills with ability to conduct in depth analysis of complicated claim situations while assessing the associated risks
  • In depth understanding of claim payments, accounting and suspense related tasks
  • Excellent judgement and decision making skills
  • Excellent written and verbal communication
  • Able to operate effectively in a fast-paced environment while maintaining a professional image and positive attitude

Preferred Qualifications

Four year degree from an accredited college or university or industry experience

About Us

Americo: Were in this for life!

The roots of the Americo family of companies date back more than 100 years. Americo is a life insurance and annuity company providing innovative products to our customers. At Americo, its the people who make things work, so we hope you join us!

What Youll Love About Working at Americo:

Compensation

Our competitive pay and robust bonus program, offered to all associates, will make you feel valued.

Learning and development

We prepare you for success with a comprehensive, paid training program. Additionally, our Talent Development team creates various development opportunities for associates at every stage of their careers.

Work-life balance

We value work-life balance with our generous paid time off; you begin accruing hours every month, and they increase with tenure. All new hires earn over three weeks of paid time off annually, plus 11 paid company holidays! We also support new parents with a maternity and parental leave program, along with paid STD and LTD.

Health and well-being

We are committed to your health and are pleased to offer flexible benefits designed to support you and your family, with high quality coverage and meaningful company contributions.

Benefits include PPO and HDHP medical plan options with HSA and FSA eligibility, along with dental and vision coverage. Additionally, we provide company paid life insurance, disability coverage, a confidential EAP, a wellness program, comprehensive health resources, corporate fitness discounts, and a 401(k) plan with employer matching.


Future planning

Americo offers a 401(k) with a company match. We also have tuition reimbursement programs to further your education.

Giving back

We support several local organizations, such as Ronald McDonald House, Hope Lodge, the American Red Cross, Harvesters, and many more. Our associates volunteer their time and donate money alongside the company to make a difference in our community.

The fun stuff

Americo participates in the Kansas City Corporate Challenge, a great way to connect with coworkers. Additionally, we host events like a Royals Party at the K, a legendary Holiday Party, and in-office events with local vendors to allow associates to step away from work and enjoy each others company.

Bustling environment

Our newly renovated offices are conveniently located in downtown Kansas City, within walking distance of your favorite restaurants and attractions. Plus, youll receive complimentary paid parking near our Americo offices downtown parking is a premium, but weve got you covered.
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