ZipRecruiter

Log In

1

Integrated Claims Examiner Jobs (NOW HIRING)

Arizona Priority Care

Claims Examiner

Chandler, AZ · Hybrid

$21 - $23/hr

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person ... The Medical Claims Examiner must be customer focused, energetic, and detail-oriented. This ...

Lowe's

Senior Claims Examiner

Mooresville, NC

$61K - $102K/yr

... 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 ...

Venbrook

Senior Claims Examiner

Los Angeles, CA · On-site

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

Venbrook

Senior Claims Examiner

Los Angeles, CA · On-site

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

Nationalindemnity

Claims Examiner II

Omaha, NE · On-site +1

Investigate assigned claims reported under insurance contracts provided by affiliated Companies ... Our Wellness program is integrated into the Company culture with an online wellness portal that ...

Transamerica

Senior Claims Examiner

Cedar Rapids, IA · On-site

$48K - $55K/yr

It's part of Aegon, an integrated, diversified, international financial services group serving ... Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team ...

Aegon

Senior Claims Examiner

Cedar Rapids, IA · On-site +1

$48K - $55K/yr

It's part of Aegon, an integrated, diversified, international financial services group serving ... Monitor claims for fraud and proceed according to each situation, such as engaging the Fraud team ...

Reliance Matrix

LTD Claims Examiner II

Phoenix, AZ · 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 ...

Rsli

LTD Claims Examiner II

Charleston, WV

$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 ...

Rsli

LTD Claims Examiner II

Phoenix, AZ

$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 ...

Venbrook

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 ...

Venbrook

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 ...

Adventist Health

Health Plan Claims Examiner

Roseville, CA · On-site

$24.40 - $32.49/hr

Applies standard claims guidelines, such as coordination of benefits, workers' compensation and ... About Us Adventist Health is a faith-based, nonprofit, integrated health system serving more than ...

next page

Showing results 1-20

All JobsIntegrated Claims Examiner Jobs

Integrated Claims Examiner information

See salary details

$15

$29

$45

How much do integrated claims examiner jobs pay per hour?

As of Jun 14, 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 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 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 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
What job categories do people searching Integrated Claims Examiner jobs look for? The top searched job categories for Integrated Claims Examiner jobs are:
Integrated Claims Examiner jobs near you
Claims Examiner

Claims Examiner

Arizona Priority Care

Chandler, AZ • Hybrid

$21 - $23/hr

Full-time

Posted 23 days ago

Job description

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing Whole-Person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 3,500 providers including Primary Care, Specialty, Hospital System and ancillary provider partnerships. We have operated in the Arizona market for more than 13 years, and are based in Chandler, Arizona. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Medical Claims Examiner must be customer focused, energetic, and detail-oriented. This individual works both independently and in conjunction with internal customers to adjudicate claims and responds to provider or client inquiries in an accurate, timely and courteous manner. The Medical Claims Examiner must be professional, possess a good work ethic and be a team player.

POSITION DUTIES & RESPONSIBILITES

  • Processing of professional and facility medical services claims by reviewing and inputting data into the claims payment system using standard policies, procedures and guidelines.
  • Must meet quality/accuracy standard of 95% and production standards of 100-125 claims/day.
  • Forward claims to appropriate departments for Med Review, Eligibility, etc.
  • Verification of coverage and contract interpretation.
  • Pursues and follows up on open and pended claims promptly and independently.
  • Researches and investigates claims with multiple coverage and complexity to determine if claim is payable in accordance with various policy provisions. If payable, determine eligible payee(s) and payment amounts. If not payable, develop detailed letter of explanation based on policy provisions and claim documents.
  • Critical thinker who can maintain focus and stay on task with minimal supervision.
  • Participates and practices principles of continuous quality improvement.

EDUCATION, TRAINING AND EXPERIENCE

  • High school diploma required; college degree preferred.
  • Minimum 1-3 years of medical claims processing experience in Managed Care.
  • Strong experience and knowledge of medical claims, Medicare/Medicaid guidelines, ICD-10, HCPCS / CPT Coding, HCFA 1500's & UB04's.
  • Strong communication, analytical, organizational and problem-solving skills.
  • Excellent time management skills.
  • Proficient with Microsoft applications (Word, Excel, Outlook) and database systems.
  • Must be able to read and interpret documents such as processing and procedure manuals, medical terminology and claims rules and regulations to appropriately develop the claim.
  • Ability to write routine, professional correspondence using correct grammar and spelling.
  • Must be able to identify and define problems; collect data; establish facts and draw valid conclusions.
  • EzCap Claims payment systems knowledge is a plus but not required.
  • Must be able to consistently interact with customers in a professional and respectful manner.

*This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*

Compensation range: The hourly range for this position is: $21 - $23.