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Integrated Claims Examiner Jobs (NOW HIRING)

Claims Examiner I

Manhattan, NY · Hybrid

$50K - $54K/yr

Position Overview The Claims Examiner I is responsible for the data entry and system adjudication ... Minimum 2 years' experience in the healthcare insurance industry with knowledge of integrated ...

Claims Examiner I

Manhattan, NY · On-site

$50K - $54K/yr

Position Overview The Claims Examiner I is responsible for the data entry and system adjudication ... Minimum 2 years' experience in the healthcare insurance industry with knowledge of integrated ...

... integrating Lowe's culture, team training, and jurisdiction-specific training into the on-boarding process Conducts investigations of claims by interviewing claimants and witnesses, obtaining ...

Claims Examiner, Public Entity DEPARTMENT: Claims Services LOCATION: Onsite - Downtown LA COMPANY ... This integration has increased efficiency while maintaining the high-quality investigative services ...

Claims Examiner, Public Entity DEPARTMENT: Claims Services LOCATION: Onsite - Downtown LA COMPANY ... This integration has increased efficiency while maintaining the high-quality investigative services ...

As a Disability Claims Examiner supporting our customers during some of the most important moments of their lives. You will manage a caseload of Short Term Disability and Absence claims, applying ...

Claims Examiner I

Bakersfield, CA · On-site

$21.15 - $26.44/hr

... integrated managed health care delivery system. About the role Under management direction ... Minimum of one (1) year medical Claims Examiner processing experience. Individual must have good ...

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health ... The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific ...

UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health ... The Claims Examiner II is responsible for the adjudication of healthcare claims utilizing specific ...

LTD Claims Examiner II

Charleston, WV · On-site

$52K - $65K/yr

Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim ... Calculates benefit payments, which may include partial disability benefits, integration with other ...

Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim ... Calculates benefit payments, which may include partial disability benefits, integration with other ...

Adjudicates claims accurately and fairly in accordance with the contract, appropriate claim ... Calculates benefit payments, which may include partial disability benefits, integration with other ...

Senior Claims Examiner

Anaheim, CA · On-site

$69K - $89K/yr

Venbrook Claims brings together decades of specialized expertise by integrating respected legacy claims brands: Carl Warren & Company, DMA Claims, and OneSource Claims Management. Venbrook works ...

Senior Claims Examiner

Anaheim, CA · On-site

$69K - $89K/yr

Venbrook Claims brings together decades of specialized expertise by integrating respected legacy claims brands: Carl Warren & Company, DMA Claims, and OneSource Claims Management. Venbrook works ...

... integrated managed health care delivery system. About the role Under management direction ... This position is responsible for claims auditing and payment functions for a Knox-Keene licensed ...

As an Accounts Payable Voucher Examiner, your primary responsibility will be to review invoice ... Secure Payment System (SPS) Company Description Integrated Finance and Accounting Solutions (IFAS ...

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Integrated Claims Examiner information

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$15

$29

$45

How much do integrated claims examiner jobs pay per hour?

As of Aug 26, 2026, the average hourly pay for integrated claims examiner in the United States is $29.40, according to ZipRecruiter salary data. Most workers in this role earn between $22.36 and $35.10 per hour, depending on experience, location, and employer.

What is an integrated claims examiner?

An Integrated Claims Examiner is a professional responsible for reviewing, investigating, and processing insurance claims across multiple lines of coverage, such as health, disability, and workers’ compensation. They analyze documentation, verify the validity of claims, and ensure that payouts comply with policy terms and regulations. Integrated Claims Examiners often work with adjusters, healthcare providers, and claimants to resolve complex cases efficiently. Their role is essential in preventing fraud and ensuring fair outcomes for both insurers and policyholders.

What are some common challenges integrated claims examiners face when handling complex claims?

Integrated Claims Examiners often encounter challenges such as interpreting medical records, coordinating with multiple stakeholders, and ensuring compliance with evolving regulations. Balancing accuracy with efficiency is crucial, as thorough investigations must meet tight deadlines. Examiners frequently collaborate with healthcare professionals, policyholders, and legal teams, requiring strong communication skills and attention to detail. Staying updated on policy changes and best practices helps mitigate these challenges and supports successful claim resolutions.

What are the key skills and qualifications needed to thrive as an integrated claims examiner, and why are they important?

To thrive as an Integrated Claims Examiner, you need a solid understanding of insurance policies, claims processing, and regulatory compliance, typically supported by a relevant degree or experience in insurance or healthcare. Familiarity with claims management systems, industry-specific software, and possibly certifications like AIC (Associate in Claims) is highly valuable. Attention to detail, strong analytical thinking, and clear communication are crucial soft skills for resolving claims efficiently and fairly. These skills and qualifications are essential to ensure accurate claim assessments, minimize errors, and maintain customer trust and regulatory compliance.

What is the difference between Integrated Claims Examiner vs Claims Processor?

AspectIntegrated Claims ExaminerClaims Processor
CredentialsTypically requires insurance or claims processing certificationsOften requires basic insurance or claims processing knowledge
Work EnvironmentOffice setting, analyzing complex claimsOffice setting, processing claims data
Industry UsageUsed in insurance companies, healthcare, and government agenciesCommon in insurance and healthcare sectors
Job FocusReviewing, evaluating, and approving complex claimsEntering, verifying, and processing claims data

The Integrated Claims Examiner and Claims Processor roles both operate within insurance and healthcare industries, but the examiner focuses on evaluating complex claims, while the processor handles data entry and basic processing. Understanding these differences helps job seekers identify the right position based on their skills and career goals.

More about Integrated Claims Examiner jobs
Infographic showing various Integrated Claims Examiner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 9% Part Time, and 4% Contract. Highlights an 88% Physical, 4% Hybrid, and 8% Remote job distribution, with an average salary of $61,156 per year, or $29.4 per hour.

Claims Examiner I

MetroPlusHealth

Manhattan, NY • Hybrid

$50K - $54K/yr

Full-time

Re-posted 17 days ago


MetroPlusHealth rating

6.7

Company rating: 6.7 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

272nd of 311 rated insurance


Job description

Position Overview

The Claims Examiner I is responsible for the data entry and system adjudication of provider claims. The incumbent authorizes final disposition of claims within prescribed guidelines in an accurate and timely manner.

Scope of Role & Responsibilities:

  • Process claims involving medical and/or surgical services; screens for complete member/provider information
  • Apply administrative policies when necessary, utilizing the claims processing manuals
  • Authorizes the generation of letters/questionnaires to providers to obtain additional information
  • Reviews descriptions of services on claims to determine validity of charges of the presence of errors
  • Evaluates and examines claims pended by the system due to contractual and/or payment discrepancies
  • Maintains production and quality goals established for the department
  • Performs other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars

Required Education, Training & Professional Experience

  • Associate’s Degree required; and
  • Minimum 2 years’ experience in the healthcare insurance industry with knowledge of integrated claims processing; or
  • A satisfactory equivalent combination of education, training, and experience
  • Proficiency with data entry skills
  • Through knowledge of medical terminology, CPT, ICD-p, and Revenue Codes

Professional Competencies

  • Integrity and Trust
  • Customer Focus
  • Functional/Technical skills
  • Written/Oral Communication

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