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Insurance Claim Examiner Jobs (NOW HIRING)

Reviews claim and policy information to provide background for investigation. Conducts 3-part ... with insured, claimant, and medical providers. Evaluates the facts gathered through the ...

Reviews claim and policy information to provide background for investigation. Conducts 3-part ... with insured, claimant, and medical providers. Evaluates the facts gathered through the ...

You will handle moderate to complex claim issues, ensuring that all necessary documentation is ... One80 Intermediaries is part of Arrowhead Intermediaries, a global insurance distribution platform ...

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Insurance Claim Examiner information

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$40K

$61.6K

$92K

How much do insurance claim examiner jobs pay per year?

As of Jun 7, 2026, the average yearly pay for insurance claim examiner in the United States is $61,600.00, according to ZipRecruiter salary data. Most workers in this role earn between $54,000.00 and $65,500.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an Insurance Claim Examiner, and why are they important?

To thrive as an Insurance Claim Examiner, you need a solid understanding of insurance policies, claims procedures, and investigative techniques, usually supported by a bachelor's degree in a related field. Familiarity with claims management software, regulatory compliance systems, and industry certifications like AIC (Associate in Claims) are typically required. Attention to detail, strong analytical thinking, and effective communication are standout soft skills for this role. These competencies enable accurate claim assessments, minimize fraud, and maintain trust with policyholders and stakeholders.

What does an Insurance Claim Examiner do?

An Insurance Claim Examiner reviews insurance claims to determine their validity and ensures that claims are processed accurately according to policy terms. They investigate claims by gathering information, assessing documentation, and sometimes consulting with medical or legal experts. Their goal is to confirm that claims are legitimate and to determine the appropriate payout or denial. Examiners also help prevent fraud and ensure compliance with laws and company guidelines. They play a critical role in balancing customer service with protecting the financial interests of the insurance company.

What are some common challenges faced by Insurance Claim Examiners, and how can they be managed on the job?

Insurance Claim Examiners often encounter challenges such as handling complex claims, managing tight deadlines, and ensuring compliance with ever-changing regulations. To manage these, examiners typically rely on strong organizational skills, attention to detail, and ongoing professional development to stay updated on industry standards. Collaboration with adjusters, legal teams, and policyholders is also key to resolving issues efficiently and fairly, while maintaining clear communication helps prevent misunderstandings and delays.
More about Insurance Claim Examiner jobs
What cities are hiring for Insurance Claim Examiner jobs? Cities with the most Insurance Claim Examiner job openings:
What states have the most Insurance Claim Examiner jobs? States with the most job openings for Insurance Claim Examiner jobs include:
Infographic showing various Insurance Claim Examiner job openings in the United States as of May 2026, with employment types broken down into 1% As Needed, and 99% Full Time. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $61,600 per year, or $29.6 per hour.

$77K - $87K/yr

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 16 days ago


Job description

Overview

The Lead Claim Examiner is responsible for prompt and efficient investigation, evaluation and settlement or declination of insurance claims through effective research, negotiation and interaction with insureds, claimants and medical providers. Maintains a solid understanding of AmTrust's mission, vision, and values. Upholds the standards of AmTrust and the Claims organization.

Responsibilities
  • Follows AmTrust policies and procedures in managing claims.
  • Investigates the claim and coverage by making timely and appropriate contact with involved or interested parties including but not limited to the insured, claimant, witnesses and medical providers.
  • Evaluates, establishes, maintains and adjusts reserves based on fact, company standard and experience.
  • Skillfully negotiates claims, turning adverse perspectives into quick resolution. Gains trust of other parties to negotiations and demonstrates good sense of timing. Approaches discussions from merits or strengths of case.
  • Leverages strong critical thinking and decision-making skills to gather, assess, analyze, question, verify, interpret and understand key or root issues.
  • Establishes effective relationships with internal or assigned counsel for customized defense plan. Applies company principles and standards including planning, organizing and monitoring legal panel services and cost in partnership with internal legal counsel.
  • Communicates with internal managed care and medical resources to ensure coordination with medical providers, injured workers and employers in developing return to work strategies and treatment plans.  
  • Obtain medical records (past and present), police, ambulance and other agency reports as required.
  • Provides insights and input when reviewing claims of others. May be sought out by others for advice.
  • Writes in a clear, succinct and fact-based manner in claims files as well as in other communication.
  • Manages mail and diary entries effectively and efficiently.
  • Provides exceptional customer service.
  • Performs other functional duties as requested or required.
Qualifications

Required:

  • 3+ years experience as a Workers Comp adjuster
  • MS Office experience (Work, Excel, Outlook)
  • Effective negotiation skills
  • Strong verbal and written communication skills
  • Ability to prioritize work  load to meet deadlines
  • Ability to manage multiple tasks in a fast-paced environment

This job description is designed to provide a general overview of the requirements of the job and does not entail a comprehensive listing of all activities, duties, or responsibilities that will be required in this position. AmTrust has the right to revise this job description at any time

The expected salary range for this role is $77,500-87,000 annual.

Please note that the salary information shown above is a general guideline only. Salaries are based upon a wide range of factors considered in making the compensation decision, including, but not limited to, candidate skills, experience, education and training, the scope and responsibilities of the role, as well as market and business considerations

What We Offer

AmTrust Financial Services offers a competitive compensation package and excellent career advancement opportunities. Our benefits include: Medical & Dental Plans, Life Insurance, including eligible spouses & children, Health Care Flexible Spending, Dependent Care, 401k Savings Plans, Paid Time Off.

AmTrust strives to create a diverse and inclusive culture where thoughts and ideas of all employees are appreciated and respected. This concept encompasses but is not limited to human differences with regard to race, ethnicity, gender, sexual orientation, culture, religion or disabilities.

AmTrust values excellence and recognizes that by embracing the diverse backgrounds, skills, and perspectives of its workforce, it will sustain a competitive advantage and remain an employer of choice. Diversity is a business imperative, enabling us to attract, retain and develop the best talent available. We see diversity as more than just policies and practices. It is an integral part of who we are as a company, how we operate and how we see our future.

Employment Type: FULL_TIME