Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Claims Examiner
Bellaire, TX · On-site
Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Claims Examiner
Bellaire, TX · On-site
Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Claims Examiner
Whittier, CA · On-site
$30 - $32/hr
PIH Health Physicians is seeking a highly skilled Claims Examiner to support its finance and accounting department. The ideal candidate will have experience adjudicating medical claims, including UB ...
Quick apply
Claims Examiner
Whittier, CA · On-site
$30 - $32/hr
PIH Health Physicians is seeking a highly skilled Claims Examiner to support its finance and accounting department. The ideal candidate will have experience adjudicating medical claims, including UB ...
Claims Examiner
Bellaire, TX · On-site
Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Claims Examiner
Bellaire, TX · On-site
Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health ...
Claims Examiner/Senior Claims Examiner
$65K - $115K/yr
We are seeking Workers' Compensation Claims Examiners and Senior Claims Examiners to join our team ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Claims Examiner/Senior Claims Examiner
$65K - $115K/yr
We are seeking Workers' Compensation Claims Examiners and Senior Claims Examiners to join our team ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Medical Claims Examiner
Los Angeles, CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
Medical Claims Examiner
Los Angeles, CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
Irving, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
Irving, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
San Antonio, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
San Antonio, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner
Miami, FL · On-site
Claims Examiner Department: Claims Reports to: Claims Supervisor Date: Job Summary Are you looking ... Familiarity with medical records, health charts, aftercare summaries and related medical ...
Quick apply
Claims Examiner
Miami, FL · On-site
Claims Examiner Department: Claims Reports to: Claims Supervisor Date: Job Summary Are you looking ... Familiarity with medical records, health charts, aftercare summaries and related medical ...
Claims Examiner
$28.85 - $33.65/hr
Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
Claims Examiner
$28.85 - $33.65/hr
Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
Claims Examiner/Senior Claims Examiner
Walnut Creek, CA · On-site
$65K - $115K/yr
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Claims Examiner/Senior Claims Examiner
Walnut Creek, CA · On-site
$65K - $115K/yr
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Claims Examiner I
Irving, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
Irving, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
San Antonio, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Claims Examiner I
San Antonio, TX · On-site
WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of ... As a Claim Examiner, you will handle processing and adjudication for healthcare claims. This will ...
Medical Claims Examiner
CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
Medical Claims Examiner
CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
Claims Examiner
San Bernardino, CA · On-site
$28.85 - $33.65/hr
Description: JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
Claims Examiner
San Bernardino, CA · On-site
$28.85 - $33.65/hr
Description: JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
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 ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
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 ... Two years of healthcare claims processing or claims adjudication experience, including experience ...
Claims Examiner/Senior Claims Examiner
$65K - $115K/yr
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Claims Examiner/Senior Claims Examiner
$65K - $115K/yr
Our Claims Examiners are expected to handle claims with the utmost good faith, fully aligned with ... Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
Medical Claims Examiner
Los Angeles, CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
Quick apply
Medical Claims Examiner
Los Angeles, CA · On-site +1
$24 - $30/hr
If you're passionate about improving healthcare, we'd love to meet you. Best-in-Class Benefits and ... To thrive as the Medical Claims Examiner, you should have: * Minimum of 2 years of medical claims ...
Claims Examiner
Miami, FL · On-site
Claims Examiner Department: Claims Reports to: Claims Supervisor Date: Job Summary Are you looking ... Familiarity with medical records, health charts, aftercare summaries and related medical ...
Quick apply
Claims Examiner
Miami, FL · On-site
Claims Examiner Department: Claims Reports to: Claims Supervisor Date: Job Summary Are you looking ... Familiarity with medical records, health charts, aftercare summaries and related medical ...
Health Claims Examiner information
See salary details
$15.14 - $16.24
7% of jobs
$16.24 - $17.33
13% of jobs
$18.07 is the 25th percentile. Wages below this are outliers.
$17.33 - $18.42
7% of jobs
$18.42 - $19.51
7% of jobs
$19.51 - $20.61
9% of jobs
The median wage is $20.94 / hr.
$20.61 - $21.70
19% of jobs
$21.70 - $22.79
9% of jobs
$23.02 is the 75th percentile. Wages above this are outliers.
$22.79 - $23.89
12% of jobs
$23.89 - $24.98
9% of jobs
$24.98 - $26.07
3% of jobs
$26.07 - $27.16
3% of jobs
$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?
| Aspect | Health Claims Examiner | Medical Claims Processor |
|---|---|---|
| Required Credentials | High school diploma or equivalent; certification may enhance prospects | High school diploma or equivalent; on-the-job training often provided |
| Work Environment | Insurance companies, government agencies, healthcare organizations | Insurance companies, healthcare providers, third-party administrators |
| Job Responsibilities | Review and evaluate insurance claims for accuracy and compliance | Process 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:
Texas Children's Hospital rating
8.3
Based on 174 frontline employees who took The Breakroom Quiz
79th of 1,055 rated hospitals
Job description
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 review, research, and a detailed format of claim processing procedures.
Think you've got what it takes?
Job Duties & Responsibilities
Adjudicate claims received into processing system.
Thoroughly reviews, investigates, and adjudicates claims daily, working oldest to newest claim in 30 days or less, and 98% of the time.
Examiners should process at least 14 claims per hour, or 98 claims per day.
Conducts review and investigation of pended claims and follow up with internal and external departments to finalize claims resolution within 30 days.
Macess requests are processed within 30 days of receipt, with a 98% accuracy, to ensure timely resolution of claims, in adherence with HHSC regulatory requirements.
The claims are processed accurately as defined by standard guidelines.
The claims should be adjudicated with a 98% procedural accuracy rate monthly as reviewed by weekly audit reports.
The claims should be adjudicated with a 98% accuracy rate monthly as reviewed by returned claims for adjustment review.
The claims that are manually adjudicated must have notes entered as reviewed by weekly audits, check run, returned claims, management review 98% of the time.
Clear concise documentation/notes must be entered for each claim reviewed, which provides a historical reference of how the claim was processed at the time of adjudication.
Complete special projects as requested.
Skills & Requirements
Required H.S. Diploma or GED
Required 1 year claims examination experience
Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.
To join our community of 15,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities.
Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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