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Complex Claims Examiner Jobs (NOW HIRING)

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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 ...

Sigma Systems, Inc.

Claims Examiner

Irving, TX

The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as ...

Rylem Staffing

Senior Claims Examiner

Irving, TX · On-site

The Claims Examiner Senior is responsible for reviewing, analyzing, researching, and resolving complex medical claims in accordance with claims processing guidelines and desktops, as well as ...

New

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

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 ...

Network Adjusters, Inc.

Claims Examiner

Denver, CO · On-site

$85K - $125K/yr

Network Adjusters is seeking experienced Claims Examiners to join our third-party administrative ... Handle complex commercial and bodily injury claims, including in-depth file reviews, damage ...

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 ...

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Complex Claims Examiner information

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How much do complex claims examiner jobs pay per hour?

As of Jul 14, 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.

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.

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 are Complex Claims Examiners?

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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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 91% Full Time, 7% Part Time, and 2% Contract. Highlights an 86% Physical, 4% Hybrid, and 10% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Examiner III - Signal Hill, CA

Martins Investment Group

Signal Hill, CA • On-site, Remote

$90K - $100K/yr

Full-time

Re-posted 7 days ago

Job description

WORKERS' COMPENSATION CLAIMS EXAMINER III 100% REMOTESignal Hill, CA - report onsite quarterly or annuallyDetails:Experience:5+ years CA workers? compensation claims experienceLicense:CA SIPCaseload:150 180 workers? compensation files, including very complex claimsSalary range:$90,000 - $100,000Location:Remote must live in CAStatus:Full-time / regular (Direct hire)Needed by:ASAPPOSITION SUMMARY:Under minimal supervision manages all aspects of indemnity claims handling from inception to conclusion within established authority and guidelines.This position requires considerable interaction with clients, claimants on the phone, and with management, other Claims Examiners, and other staff in the office; therefore consistently being at work in the office, in a timely manner, is inherently required of this position.DUTIES AND RESPONSIBILITIES:Effectively manages a caseload of 150 to 180 workers? compensation files, including very complex claims.* Initiates and conducts investigation in a timely manner.* Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines.* Manages medical treatment and medical billing, authorizing as appropriate.* Refers cases to outside defense counsel. Directs and manages as appropriate.* Communicates with claimants, providers and vendors regarding claims issues.* Computes and set reserves within Company guidelines. Limits are larger than those allowed for Claims Examiner I and Claims Examiner II.* Settles and/or finalize all claims and obtains authority as designated.* Maintains diary system for case review and documents file to reflect the status and work being performed on the file.* Communicates appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns.* Adheres to all Company policies and procedures.* Conducts file reviews independently.* Other duties as assigned.*Essential job function.EQUIPMENT OPERATED/USED:Computer, fax machine, copier, printer, and other standard office equipment.SPECIAL EQUIPMENT OR CLOTHING:Appropriate office attire.QUALIFICATIONS:Education/Experience:Bachelor?s degree in related field (preferred); five (5) or more years related experience; or equivalent combination of education and experience.Knowledge, Skills and Abilities: Technical knowledge of statutory regulations and medical terminology. Analytical skills. Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients and staff. Ability to interact with persons at all levels in the business environment. Ability to independently and effectively manage very complex claims. Proficient in Word and Excel (preferred).Other Qualifications: Certifications and/or licenses as required by State regulation.CA SIP license required.If you're an experienced Workers? Compensation professional looking for the opportunity to handle complex claims, work within a collaborative team environment, and advance your career with a growing organization, we'd love to connect.