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Integrated Claims Examiner Jobs (NOW HIRING)

Elevance Health

Subrogation Examiner

Waukesha, WI

This approach promotes productivity, supports work-life integration, and ensures essential face-to ... The Subrogation Examiner is responsible for researching and examining routine health claims that ...

Elevance Health

Subrogation Examiner

Louisville, KY · On-site

This approach promotes productivity, supports work-life integration, and ensures essential face-to ... The Subrogation Examiner is responsible for researching and examining routine health claims that ...

Elevance Health

Subrogation Examiner

Atlanta, GA

This approach promotes productivity, supports work-life integration, and ensures essential face-to ... The Subrogation Examiner is responsible for researching and examining routine health claims that ...

HealthEdge

Temporary Claims Processor

$25/hr

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 ...

HealthEdge

BPaaS Claims Processor

$25/hr

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 ...

HealthEdge

Temporary BPaaS Claims Processor

$17 - $21.50/hr

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 ...

New

HealthEdge

Temporary Claims Processor

$25/hr

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 ...

New

HealthEdge

Temporary BPaaS Claims Processor

$17.50 - $22/hr

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 ...

New

The Hartford

AVP Applied AI, Claims

Hartford, CT · Hybrid

The Hartford is hiring an AVP leading Applied AI for the Claims organization. This leader will play ... Influence technology integration and platform strategy by partnering with Technology, Data, AI ...

The Hartford

AVP Applied AI, Claims

Chicago, IL · Hybrid

The Hartford is hiring an AVP leading Applied AI for the Claims organization. This leader will play ... Influence technology integration and platform strategy by partnering with Technology, Data, AI ...

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Integrated Claims Examiner information

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$15

$29

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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
Health Plan Claims Examiner

Health Plan Claims Examiner

Adventist Health

Roseville, CA

Full-time

Medical, Dental, Vision

Posted 17 days ago

Adventist Health rating

7.9

Company rating: 7.9 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

105th of 872 rated healthcare providers

Job description

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Reviews, evaluates and authorizes payment of medical, dental, vision, and prescription drug claims within the benefit descriptions and plan provisions of a variety of group plans. Determines the appropriate course of action on each claim (i.e., payment, further investigation, referral to review, denial, etc.). Responds verbally and in writing to claimants and providers regarding plan benefits and eligibility. Applies standard claims guidelines, such as coordination of benefits, workers' compensation and third-party investigations. Documents claims files regarding every verbal communication.

Job Requirements:

Education and Work Experience:

  • Associate's/Technical Degree or equivalent combination of education/related experience: Required
  • Bachelor's Degree: Preferred
  • Three years' experience processing health claims on a computerized claims payment system: Preferred

Essential Functions:

  • Processes medical claims for payment up to $15,000.00 per Health Plan benefit descriptions. Assists in processing of vision and dental claims per Vision and Dental plan descriptions. Possesses thorough knowledge of assigned plan benefits, provisions, and exclusions. Demonstrates proficiency with ICD-10, CPT and HCPCS codes, modifiers and guidelines, and application of appropriate benefit codes.
  • Coordinates benefits with primary carriers, when appropriate. Coordinates with Utilization Review when appropriate.
  • Researches and documents rejected or erroneous claims and forwards them to the Health Plan Claims Manager for correction.
  • Handles incoming calls from plan members and healthcare providers for assigned plans. Maintains established productivity and quality standards of 99% accuracy. Participates in special projects as assigned by management.
  • Solves and escalates operational problems and technical issues; modifies existing tools or processes. Works under general supervision.
  • Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.

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