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Health Claims Examiner Jobs (NOW HIRING)

Western Growers

Claims Examiner I

Fresno, CA · On-site +1

$40K - $52K/yr

Ifyou'relooking for a career that provides affordable health benefit solutions to the people who ... Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and ...

Imagenet

Claims Examiner - Remote

Tampa, FL · Remote

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ...

Imagenet

Claims Examiner - Remote

Tampa, FL · On-site +1

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ...

Imagenet

Claims Examiner - Remote (Alameda)

Tampa, FL · Remote

As a Claims Examiner, you will be responsible for accurately reviewing, investigating, and ... Understanding of health claims processing/adjudication * Ability to perform basic to intermediate ...

New

Next Step Systems

Claims Examiner

Tucson, AZ · On-site

Tucson AZ Jobs, Claims Examiner, ICD10, CPT, HCPCS, In-Patient Coding, In-Patient Billing, HIPAA Regulations, MS Excel 10-Key, Electronic Health Records, EHR, Claims Processing, Accounting, Healt ...

Next Step Systems

Claims Examiner

Tucson, AZ · On-site

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

Managed Staffing

Healthcare Claims Examiner

Whittier, CA · On-site

$31 - $32/hr

Healthcare Claims Examiner Location: Whittier, CA Shift: Monday - Friday | 7:00 AM - 3:30 PM Position Overview We are seeking an experienced Claims Examiner with strong UB-92 and HCFA-1500 claims ...

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

Tucson AZ Jobs, Medical Claims Examiner, ICD10, CPT, HCPCS, HIPAA Regulations, In-Patient Coding, In-Patient Billing, Electronic Health Records, EHR, Excel, Data Entry, Claims Processing, English ...

Next Step Systems

Medical Claims Examiner

Tucson, AZ · On-site

Tucson AZ Jobs, Medical Claims Examiner, ICD10, CPT, HCPCS, In-Patient Coding, In-Patient Billing, HIPAA Regulations, MS Excel 10-Key, Electronic Health Records, EHR, Claims Processing, Healthcare, ...

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 ...

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All JobsHealth Claims Examiner Jobs

Health Claims Examiner information

See salary details

$15

$21

$27

How much do health claims examiner jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for health claims examiner in the United States is $21.11, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $23.56 per hour, depending on experience, location, and employer.

What is the difference between Health Claims Examiner vs Medical Claims Processor?

AspectHealth Claims ExaminerMedical Claims Processor
Required CredentialsHigh school diploma or equivalent; certification may enhance prospectsHigh school diploma or equivalent; on-the-job training often provided
Work EnvironmentInsurance companies, government agencies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators
Job ResponsibilitiesReview and evaluate insurance claims for accuracy and complianceProcess and input medical claims data into systems

Both roles involve handling insurance claims, but Health Claims Examiners focus on reviewing and verifying claims for accuracy and compliance, often requiring more analytical skills. Medical Claims Processors primarily input and process claims data, typically with less emphasis on review. Understanding these differences helps job seekers identify the right career path in the healthcare insurance industry.

What is a health claims examiner?

In the insurance industry, a health claims examiner works specifically with medical insurance claims and determines whether the insurance company should pay a patient for their claim. Your duties and responsibilities in this career are to review the findings of other claims workers, resolve any discrepancies their findings contain, such as missing information from the patient or the healthcare provider, audit financial records, and coordinate with benefits professionals when you are processing or adjudicating a claim. As a health claims examiner, a large part of your role is to protect the health insurance company from unnecessary financial loss and be a backstop for other examiners work.

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

To thrive as a Health Claims Examiner, you need a solid understanding of medical terminology, insurance policies, and claims processing, often supported by a high school diploma or associate degree in a related field. Familiarity with claims management software, coding systems like ICD-10 and CPT, and proficiency in Microsoft Office are typically required. Attention to detail, critical thinking, and strong organizational and communication skills help distinguish top performers in this role. These competencies are crucial for accurately evaluating claims, ensuring compliance, and maintaining efficiency in a high-volume, deadline-driven environment.

What are some common challenges health claims examiners face when reviewing insurance claims?

Health Claims Examiners often encounter challenges such as interpreting complex medical records, staying updated with changing insurance policies, and ensuring compliance with regulatory requirements. They must accurately assess claims while balancing efficiency and attention to detail, as errors can lead to financial loss or customer dissatisfaction. Collaborating with healthcare providers and insurers to resolve discrepancies is also a frequent part of the role, requiring strong communication and problem-solving skills.
More about Health Claims Examiner jobs
What cities are hiring for Health Claims Examiner jobs? Cities with the most Health Claims Examiner job openings:
What are the most commonly searched types of Health Claims Examiner jobs? The most popular types of Health Claims Examiner jobs are:
Who are the top companies hiring for Health Claims Examiner jobs? The top employers for Health Claims Examiner jobs are:
What states have the most Health Claims Examiner jobs? States with the most job openings for Health Claims Examiner jobs include:
What are popular job titles related to Health Claims Examiner jobs? For Health Claims Examiner jobs, the most frequently searched job titles are:
Health Claims Examiner jobs near you
Infographic showing various Health Claims Examiner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.

Claims Examiner I

Western Growers

Fresno, CA • On-site, Remote

$40K - $52K/yr

Full-time

Medical, Dental, Vision

Re-posted 9 days ago

Job description

Ifyou'relooking for a career that provides affordable health benefit solutions to the people who support some of the most vital industries,we'relooking for you.
At Pinnacle Claims Management, we are an innovative third-party administrator (TPA) that provides afull-suiteof comprehensive and customized health benefits administration services for self-funded companies, including health management and wellness solutions, and pharmacy benefit management. As part of the Western Growers Family of Companies, we are committed to providing our employees with everything they need to succeed and grow. We know that taking care of our clients starts with taking care of our employees.
As a keystone of our philosophy, we recognize that every person on our team comes to us with a unique background,historyand story that adds strength to our organization. Additionally, employees are encouraged to recognize that thereisn'ta work lifeanda home life, there is one life. This recognition throughout the organization emphasizes the value of finding a healthy and happy balance in every employee's life.One way this is realized for employees of Pinnacle Claims Management is flexible work arrangements with work-from-home, in-office or hybrid options.
With competitive compensation packages, premier investment support, enriching personaldevelopmentand more, we strive for our employees' job satisfaction and success.
Compensation:$40,580.28- $52,756.02with a rich benefits package that includes profit-sharing.
JOB DESCRIPTION SUMMARY
The Claims Examiner I reports to the Supervisor of Claims. Claims Examiner I is responsible for reviewing and processing medical, dental, vision, and electronic claims per state, federal, and health plan regulatory requirements and department guidelines, as well as meeting established quality and production performance benchmarks, including research and review of applicable documentation. The Claims Examiner I will thoroughly review, analyze, and research health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. The position will assist in resolving issues from providers, customer service, member services, health plan, and other internal customers.
QUALIFICATIONS
High school education or equivalent: minimum three (3) to five (5) years of experience as a Health Claims Examiner or comparable industry experience preferred.
A minimum of one (1) year experience as a Claims Examiner for medical, dental claims and vision, subrogation, and accident claims, highly desired.
Ability to interpret Plan Documents or Summary Plan Descriptions (SPD) for the purpose of accurate claim adjudication and/or benefit determination.
Basic knowledge of medical terminology. Familiar with UB-04 and HCFA 1500 forms (837/5010 format), ICD10, CPT, and HCPCS codes.
Good verbal and written communication skills.
Proficient in 10-key by touch data entry/type 40 WPM and Microsoft Office (Word, Excel, Outlook, PowerPoint) and possess a capability to quickly learn new applications.
Ability to work under pressure and adapt to changing environment
Working knowledge of Employee Retirement Income Security Act of 1974 (ERISA) claims
processing/adjudication guidelines.
Internet access provided by a cable or fiber provider with 40 MB download and 10 MB upload speeds.
Home router with wired Ethernet (wireless connections and hotspots are not permitted).
A designated room for your office or steps taken to protect company information (e.g., facing computer towards wall, etc.)
A functioning smoke detector, fire extinguisher, and first aid kit on site.
DUTIES AND RESPONSIBILITIES
Claims Processing & Quality Assurance
Adjudicate all claims types including Dental, Vision and Medical claims for inpatient and outpatient facilities, Blue Card, physician claims, In and Out of Network claims, Medicaid reclamation (HIPD), outpatient lab and radiology, accident and Third-Party Liability (TPL) claims, by calculating benefit due to approve or deny, based on SPD and within accepted corporate cycle timeframe.
Analyze patient and medical records to identify instances where investigation for determining appropriate Claim Benefits, Pricing, Prior Authorization or Coordination of Benefits is necessary and process claims accordingly.
Examine claim files for accuracy: verifications (i.e. eligibility, medical authorization, etc.); reach out to Health Care Providers to obtain necessary claims documentation.
Research through all vendor portals, including but not limited to Valenz, Occunet, Anthem Resolve benefit and eligibility issues that require detailed knowledge, support for customers within the claims processing, Company and ERISA guidelines. Process low to medium level claims, re-pricing corrections.
Research, resolve and respond to all correspondence and internal communication (Ops Connect) related to electronic and paper claims as assigned.
Maintain a Health Insurance Portability and Accountability Act (HIPAA) compliant workstation. Utilize
appropriate security techniques to ensure HIPAA required protection of all confidential/protected client and enrollee data.
Meet and maintain individual and department productivity and quality standards.
Problem Solving, Judgement & Compliance
Examine a problem, set of data or text and consider multiple sides of an issue, weighs consequences before making a final decision.
Ensure compliance with all appropriate policies and practices, local, State, Federal regulations and requirements regarding claims and contract administration.
Partner with peers to document and analyze functional requirements, identify gaps and alternative approaches to resolve problems.
Contribute to defining and documenting standards and periodically reviewing them to integrate appropriate industry standards.
Alert supervisors to potential higher risk compliance issues.
Make timely and effective decisions based on available information
Recognize issues, analyzes, solves problems, researches, identifies trends and determines actions needed to advance the decision-making process within a realistic timeframe. Follows up as necessary.
Involve the appropriate people in defining, understanding the impact and resolving problems.
Other
Utilize all capabilities to satisfy one mission - to enhance the competitiveness and profitability of our members. Do everything possible to help members succeed by being curious and striving to understand what others are trying to achieve, planning, and executing work helpfully and collaboratively. Be willing to adjust efforts to ensure that work and attitude are helpful to others, being self-accountable, creating a positive impact, and being diligent in delivering results.
Maintain internet speed of 40MB download and 10MB upload and router with wired Ethernet.
Maintain a HIPAA-compliant workstation and utilize appropriate security techniques to ensure HIPAA[1]required protection of all confidential/protected client data.
Maintain and service safety equipment (e.g. smoke detector, fire extinguisher, first aid kit).
All other duties as assigned.
PHYSICAL DEMANDS / WORK ENVIRONMENT
The physical demands and work environment described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to communicate with others. The employee frequently is required to move around the office. The employee is often required to use tools, objects, and controls. This noise level in the work environment is usually moderate.

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