... expert knowledge of claims administration and adjudication to Insurance Department staff ... Examiner Works with the Customer Service Coordinator to manage and provide direction to the ...
... expert knowledge of claims administration and adjudication to Insurance Department staff ... Examiner Works with the Customer Service Coordinator to manage and provide direction to the ...
Insurance Claims Examiner II
WI · On-site
... expert knowledge of claims administration and adjudication to Insurance Department staff ... Examiner Works with the Customer Service Coordinator to manage and provide direction to the ...
Insurance Claims Examiner II
WI · On-site
... expert knowledge of claims administration and adjudication to Insurance Department staff ... Examiner Works with the Customer Service Coordinator to manage and provide direction to the ...
Bilingual Claims Examiner
Hackensack, NJ · On-site
Entry-Level Claims Examiner (Bilingual Korean Required) Position Summary: We are seeking a ... No prior insurance experience is required--we provide comprehensive training. The ideal candidate ...
Bilingual Claims Examiner
Hackensack, NJ · On-site
Entry-Level Claims Examiner (Bilingual Korean Required) Position Summary: We are seeking a ... No prior insurance experience is required--we provide comprehensive training. The ideal candidate ...
Commercial Property Claims Examiner II (Remote)
Los Angeles, CA · On-site +1
$85K - $95K/yr
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Commercial Property Claims Examiner II (Remote)
Los Angeles, CA · On-site +1
$85K - $95K/yr
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Quick apply
Additionally, this role will examine and authorize commercial insurance claims investigated by independent adjusters. Lastly, the commercial property examiner will review claim forms and other ...
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Catastrophe Property Claims Examiner III (Remote)
Los Angeles, CA · On-site +1
$90K - $100K/yr
POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
Catastrophe Property Claims Examiner III (Remote)
Los Angeles, CA · On-site +1
$90K - $100K/yr
POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
Claims Examiner
Salt Lake City, UT · On-site
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Claims Examiner
Salt Lake City, UT · On-site
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Claims Examiner
Salt Lake City, UT · On-site
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Quick apply
Claims Examiner
Salt Lake City, UT · On-site
Claims Examiner Overview Perform claim processing for long term care (LTC) insurance claims and support the overall Long-Term Care Department. This work requires competent customer communication ...
Salary: $90,000-$100,000 POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with ...
Quick apply
Salary: $90,000-$100,000 POSITION SUMMARY The Catastrophe Claims Examiner III processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with ...
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI
Honolulu, HI · Hybrid
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI * Our client, a large and growing insurance carrier, is seeking a Claims Examiner to join their team in ...
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI
Honolulu, HI · Hybrid
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI * Our client, a large and growing insurance carrier, is seeking a Claims Examiner to join their team in ...
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI
Honolulu, HI · Hybrid
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI * Our client, a large and growing insurance carrier, is seeking a Claims Examiner to join their team in ...
Quick apply
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI
Honolulu, HI · Hybrid
Claims Examiner - Property and Casualty Insurance - Base Salary to 90k/year - Honolulu, HI * Our client, a large and growing insurance carrier, is seeking a Claims Examiner to join their team in ...
Claims Examiner
Tucson, AZ · On-site
Monitor copays, deductibles, insurance verification, and authorizations. Analyze incoming and ... Claims Examiner Responsibilities: - Submit claims and encounters in a timely manner. - Review and ...
Claims Examiner
Tucson, AZ · On-site
Monitor copays, deductibles, insurance verification, and authorizations. Analyze incoming and ... Claims Examiner Responsibilities: - Submit claims and encounters in a timely manner. - Review and ...
Claims Examiner MedMal
Pawtucket, RI · On-site
$100K - $140K/yr
Medical Malpractice Liability Claims Examiner - Pawtucket, RI Insurance Claims Examiner Adjuster Specialist Professional Liability Medical Malpractice MedMal Allied Healthcare _ . REMOTE - WORK FROM ...
Claims Examiner MedMal
Pawtucket, RI · On-site
$100K - $140K/yr
Medical Malpractice Liability Claims Examiner - Pawtucket, RI Insurance Claims Examiner Adjuster Specialist Professional Liability Medical Malpractice MedMal Allied Healthcare _ . REMOTE - WORK FROM ...
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
Catastrophe Property Claims Examiner II (Remote)
Los Angeles, CA · On-site +1
$80K - $90K/yr
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
Catastrophe Property Claims Examiner II (Remote)
Los Angeles, CA · On-site +1
$80K - $90K/yr
POSITION SUMMARY The Catastrophe Claims Examiner II processes insurance claims for property losses based on coverage, appraisal, and verifiable damage. They interact with independent adjusters and ...
Claims Examiner
Tucson, AZ · On-site
Monitor copays, deductibles, insurance verification, and authorizations. Analyze incoming and ... Claims Examiner Responsibilities: - Submit claims and encounters in a timely manner. - Review and ...
Claims Examiner
Tucson, AZ · On-site
Monitor copays, deductibles, insurance verification, and authorizations. Analyze incoming and ... Claims Examiner Responsibilities: - Submit claims and encounters in a timely manner. - Review and ...
Insurance Claims Examiner information
See salary details
$40K - $44.7K
8% of jobs
$44.7K - $49.5K
7% of jobs
$53.2K is the 25th percentile. Wages below this are outliers.
$49.5K - $54.2K
12% of jobs
$54.2K - $58.9K
14% of jobs
The median wage is $60.2K / yr.
$58.9K - $63.6K
33% of jobs
$64.2K is the 75th percentile. Wages above this are outliers.
$63.6K - $68.4K
11% of jobs
$68.4K - $73.1K
7% of jobs
$73.1K - $77.8K
4% of jobs
$77.8K - $82.5K
3% of jobs
$82.5K - $87.3K
1% of jobs
$87.3K - $92K
0% of jobs
$40K
$61.6K
$92K
How much do insurance claims examiner jobs pay per year?
What does an Insurance Claims Examiner do?
What is the difference between Insurance Claims Examiner vs Insurance Adjuster?
| Aspect | Insurance Claims Examiner | Insurance Adjuster |
|---|---|---|
| Credentials | Typically requires a high school diploma or equivalent; some roles prefer certifications like CPCU or AIC | Requires similar credentials; certifications like AIC or CPCU are common |
| Work Environment | Office-based, reviewing claims and documentation | Field or office-based, inspecting damages and interviewing claimants |
| Employer & Industry | Insurance companies, government agencies | Insurance companies, independent adjusting firms |
| Search & Comparison Intent | Often compared for claims processing roles | Related to claims evaluation and damage assessment |
Both Insurance Claims Examiners and Insurance Adjusters work within the insurance industry, handling claims and requiring similar certifications. While Claims Examiners primarily review documentation in office settings, Adjusters often inspect damages in the field. Understanding these differences helps job seekers identify the right role based on work environment and responsibilities.
What are some common challenges Insurance Claims Examiners face in their daily work?
What are the key skills and qualifications needed to thrive as an Insurance Claims Examiner, and why are they important?

Full-time
Posted 28 days ago
Job description
Here’s what you’ll be doing:
Level II
Level III
1
Analyzes and processes minimum of 200 claims daily to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims
Analyzes and processes minimum of 400 claims to determine plan liability; reviews payment Purchased Referred Care, medical, dental and vision claims
2
Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations
Compiles, submits documents, and tracks claims for CHEF, (Catastrophic Health Emergency Fund), for reimbursement, to Bemidji Area Contract Health for high-cost cases, following current IHS guidelines and regulations
3
Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments
Collaborates with the Eligibility team to ensure payer of last resort stance is utilized when handling Purchased Referred Care claims and payments
4
Assists with other research and development projects as directed by Management; obtains and maintains necessary certification for Health Insurance Marketplace CAC
Provides training and guidance through expert knowledge of claims administration and adjudication to Insurance Department staff; responsible for the timely response to formal appeals from members, employees, clients and providers
5
Reviews, resolves and/or escalates Level 2 claims appeals; releases claims up to the designated draft authority for Level 2 Claims Examiner
Works with the Customer Service Coordinator to manage and provide direction to the utilization review and case management vendor; identifies and manages claims with potential subrogated recovery
6
Ensures that claims adjudication complies with all FCPID standards and protocols; reviews claims for possible abuses and/or fraud and bring to the attention of management
Oversees the repricing processes to ensure the integrity of the product; investigates claims referred by staff for possible abuse and fraud
What you’ll need to be successful:
Level II
Level III
1
High School Diploma or GED
High School Diploma or GED
2
Five (5) years of experience in medical claims processing
Five (5) years of experience in medical claims processing
3
Three (3) years in customer service
Three (3) years in customer service
4
Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards
Two (2) years in a lead or supervisory capacity
5
Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology
Knowledge of Indian Health Service guidelines as it pertains to payment of medical providers and health benefits claims processing standards
6
Knowledge of insurance principles and/or procedures
Knowledge of NCCI and CMS coding/billing standards, CPT-4, ICD-9, ICD-10, DRG and HCPS and medical terminology
7
Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment
Knowledge of insurance principles and/or procedures
8
Must successfully pass all applicable background checks and drug screens
Skill in operating various word-processing, spreadsheets, and database software programs in a Windows environment
9
Must successfully pass all applicable background checks and drug screens
Benefits you’ll love:
- Approximately 5 weeks of paid time off annually
- 3 weeks of paid holidays
- Premium free health insurance
- Flexible spending accounts
- Short term disability
- Life insurance
- 401k with match
About Forest County Potawatomi
Sourced by ZipRecruiter
Company size
501 - 1,000 Employees
Headquarters location
Crandon, WI, US
Year founded
1880