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Insurance Claims Examiner Jobs (NOW HIRING)

Diedre Moire Corp.

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 ...

Next Step Systems

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 ...

Next Step Systems

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 ...

Diedre Moire Corp.

Claims Examiner MedMal

Reading, PA · On-site

$100K - $140K/yr

Medical Malpractice Liability Claims Examiner - Reading, PA Insurance Claims Examiner Adjuster Specialist Professional Liability Medical Malpractice MedMal Allied Healthcare _ . REMOTE - WORK FROM ...

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All JobsInsurance Claims Examiner Jobs

Insurance Claims Examiner information

See salary details

$40K

$61.6K

$92K

How much do insurance claims examiner jobs pay per year?

As of Jul 22, 2026, the average yearly pay for insurance claims 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 does an Insurance Claims Examiner do?

An Insurance Claims Examiner is responsible for reviewing insurance claims to determine their validity and ensure that payouts are made according to policy guidelines. They investigate the details of claims, verify information, and may consult with medical or legal experts. The examiner determines if claims are covered, recommends approval or denial, and helps prevent fraudulent or excessive claims. Their work ensures that policyholders receive fair treatment while protecting the insurance company's financial interests.

What is the difference between Insurance Claims Examiner vs Insurance Adjuster?

AspectInsurance Claims ExaminerInsurance Adjuster
CredentialsTypically requires a high school diploma or equivalent; some roles prefer certifications like CPCU or AICRequires similar credentials; certifications like AIC or CPCU are common
Work EnvironmentOffice-based, reviewing claims and documentationField or office-based, inspecting damages and interviewing claimants
Employer & IndustryInsurance companies, government agenciesInsurance companies, independent adjusting firms
Search & Comparison IntentOften compared for claims processing rolesRelated 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?

Insurance Claims Examiners often encounter the challenge of balancing thorough investigation with timely claims processing. Reviewing complex documentation, communicating with claimants and other stakeholders, and detecting potential fraud can be demanding, especially when managing a high-volume caseload. Examiners must stay updated on changing regulations and policy guidelines while maintaining objectivity and empathy in sometimes stressful situations. Developing strong organizational and communication skills is key to overcoming these challenges and delivering fair, accurate outcomes.

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

To thrive as an Insurance Claims Examiner, you need a solid understanding of insurance policies, claim procedures, and investigative techniques, typically supported by a bachelor's degree in a related field. Familiarity with claims management software, regulatory compliance tools, and sometimes certifications like AIC (Associate in Claims) are commonly required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for evaluating claims and interacting with claimants and stakeholders. These skills ensure accurate claim assessments, minimize fraudulent payouts, and maintain trust with clients and insurers.
More about Insurance Claims Examiner jobs
What cities are hiring for Insurance Claims Examiner jobs? Cities with the most Insurance Claims Examiner job openings:
Who are the top companies hiring for Insurance Claims Examiner jobs? The top employers for Insurance Claims Examiner jobs are:
What states have the most Insurance Claims Examiner jobs? States with the most job openings for Insurance Claims Examiner jobs include:
What job categories do people searching Insurance Claims Examiner jobs look for? The top searched job categories for Insurance Claims Examiner jobs are:
What are popular job titles related to Insurance Claims Examiner jobs? For Insurance Claims Examiner jobs, the most frequently searched job titles are:
Insurance Claims Examiner jobs near you
Infographic showing various Insurance Claims Examiner job openings in the United States as of July 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution, with an average salary of $61,600 per year, or $29.6 per hour.
Insurance Claims Examiner II

Insurance Claims Examiner II

Forest County Potawatomi Community

Crandon, WI • On-site

Full-time

Re-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

Apply