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Health Claims Examiner Jobs (NOW HIRING)

Insperity

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 ...

Insperity

Medical Claims Examiner

CA · Remote

$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 ...

MetroPlusHealth

Claims Examiner II

Manhattan, NY · On-site

$54K - $64K/yr

Position Overview The ideal candidate will have experience processing healthcare claims in a high ... Audit work of assigned claims examiners to ensure accuracy. * Identify policies of common errors ...

Peyton Resource Group

Claims Examiner

San Antonio, TX · On-site

Position Summary We are seeking a detail-oriented Claims Examiner & Support Specialist I to support healthcare claims operations through accurate claims processing, provider communication, and ...

Adecco

Medical Claims Examiner

San Antonio, TX · On-site

$22.50/hr

Claims Examiner - San Antonio, TX ($22.50/hr, Mon-Fri 8am-5pm) Adecco is hiring a Claims Examiner responsible for processing health plan claims and supporting provider inquiries. Key Requirements ...

MetroPlusHealth

Claims Examiner II

Manhattan, NY · Hybrid

$54K - $64K/yr

Position Overview The ideal candidate will have experience processing healthcare claims in a high ... Audit work of assigned claims examiners to ensure accuracy. * Identify policies of common errors ...

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Health Claims Examiner information

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How much do health claims examiner jobs pay per hour?

As of Aug 27, 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 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.

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.

How much do health claims examiners make in the US?

Health claims examiners in the US typically earn a median annual salary of around $45,000 to $55,000, with experienced professionals earning higher. Salaries can vary based on location, experience, and employer, and the role often requires attention to detail and knowledge of insurance policies and medical terminology.

Is claims processing a stressful job?

Health Claims Examiners often find claims processing to be a demanding task due to strict deadlines, detailed review requirements, and the need for accuracy. The job requires strong attention to detail, good organizational skills, and the ability to handle high volumes of claims efficiently, which can contribute to stress levels.
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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, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.

Claims Examiner

Trawick International Inc

Coral Gables, FL • On-site

Full-time

Medical, Retirement, PTO

Re-posted 18 days ago

Job description

Job Title: 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 help our customers find solutions to their questions, if the answer is yes, then you found the perfect fit! 

SureGo Administrative Services is looking for someone who is self-motivated, enthusiastic, thoughtful, and patient. Our Claims Examiners must have strong problem-solving skills, coupled with the natural ability to provide empathy for the customer – always taking the time to patiently listen and understand their questions to help find a viable solution, while providing them with a memorable customer experience. 

This is a permanent work from home position that includes a virtual five week paid training program, which will successfully prepare you for handling incoming calls from our customers. At this time, we are accepting applications from individuals who reside in the United States only. 


Key Responsibilities

  • Diligently review reports to ensure that no errors have been made in the appraisal process. 
  • Determine whether payouts are reasonable. 
  • Approve, reject or refer a claim to a specialist. 
  • Meet with claimants and settle disputes. 
  • Ensure compliance with regulatory standards, company policy and guidelines. 
  • Provide assistance to claims adjusters to manage the volume of cases. 



  • Claims Examiners are responsible for timely processing and/or adjudicating medical claims according to the insurance policy provisions
  • Read and interpret insurance policy language and adjudicate claims accordingly
  • Respond to written communications from policy holders as needed with professionalism and knowledge based guidance
  • Provide professional customer service to our internal and external customers

Qualifications

  • Must have 1+ year of experience processing medical claims
  • Familiarity with medical records, health charts, aftercare summaries and related medical documentation necessary and related to the processing of medical claims
  • Current knowledge of medical coding sets HCPCS, CPT, ICD 10[GS1]
  • Understanding of Medical terminology required
  • Excellent verbal, written, and interpersonal communication skills
  • Ability to prioritize and manage multiple tasks at once
  • Ability to work independently with minimum guidance
  • Strong data entry skills and attention to detail
  • Minimum of High School Diploma or equivalent


Working Conditions

  • Remote position.
  • Private, secure, solo, distraction free workspace where you can work independently and take incoming calls during your shift.
  • Computer equipment will be provided and shipped to you prior to your start date.
  • Internet Connectivity Requirement/Remote Positions: For 100% remote positions, we require that: (you have high speed broadband cable internet service with minimum upload/download speeds of 3Mbps/30Mbps).


 

 

Benefits 


  • Monday-Friday, work from home schedule. Flex schedule with start times between 6AM-10AM 
  • 12 paid Holidays each year after 90 days
  • Medical Insurance Benefits and PTO accrual after 90 days
  • 401K investment options


Be part of a team committed to a culture of Respect, Ownership, Innovation and Integrity 


We offer exceptional professional growth opportunities; a casual, friendly work environment; and competitive wage and benefits 


SureGo Administrative Services LLC is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to characteristics such as race, color, national origin, religion, gender, age, marital status, veteran status, citizenship status, sexual orientation, gender identity, or any other status protected by law. 

 [GS1]I know that ICD-9 is old-school and different from ICD-10, but I think maybe that knowledge might still be helpful and applicable in the role. Maybe worth listing? Like a "minimum of ICD-9"?

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