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Medical Claims Examiner Jobs (NOW HIRING)

Auxiant

Claims Examiner

Cedar Rapids, IA · On-site

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

Auxiant

Claims Examiner

Madison, WI · On-site +1

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

Auxiant

Claims Examiner

Madison, WI · On-site

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

Auxiant

Claims Examiner

Madison, WI

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

Auxiant

Claims Examiner

Cedar Rapids, IA

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

Auxiant

Claims Examiner

Madison, WI

... a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans ... Responsible for processing medical claims and correspondence and handling customer service calls ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

This role applies plan and contract rules, reimbursement methodologies, and medical billing/coding ... The Claims Examiner collaborates with Provider Relations/Network, Contracting, Utilization ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA · On-site

$28.85 - $33.65/hr

JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and Independent ...

LSMA Management Inc

Claims Examiner

San Bernardino, CA

$28.85 - $33.65/hr

Description JOB SUMMARY The Claims Examiner is responsible for reviewing, analyzing, and adjudicating medical claims for a management services organization (MSO) supporting medical clinics and ...

BRMS

CLAIMS EXAMINER

Folsom, CA · On-site

$24 - $25/hr

... for medical, dental and vision plans. · Adjudicates medical claims, applies coordination of ... claim examiner II for review and processing. · Research and resolve paid and denied claims ...

BRMS Online

CLAIMS EXAMINER

Folsom, CA · On-site

$24 - $25/hr

... for medical, dental and vision plans. • Adjudicates medical claims, applies coordination of ... claim examiner II for review and processing. • Research and resolve paid and denied claims ...

BRMS

CLAIMS EXAMINER

Folsom, CA · On-site

$24 - $25/hr

Description Summary: The Claims Examiner I is responsible for ensuring claims are coded and ... Adjudicates medical claims, applies coordination of benefits as outlined in plan guidelines and ...

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Medical Claims Examiner information

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How much do medical claims examiner jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for medical claims examiner in the United States is $21.11, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $23.56 per hour, depending on experience, location, and employer.

What does a medical claims examiner do?

A Medical Claims Examiner reviews insurance claims related to healthcare to determine their validity and ensure they meet policy guidelines. They analyze medical records, verify patient and provider information, and assess whether the treatments and procedures billed are covered by the policy. Examiners may also communicate with healthcare providers and policyholders to gather additional information or clarify details. Their work helps prevent fraudulent claims and ensures timely payment for legitimate medical services.

What are the key skills and qualifications needed to thrive as a medical claims examiner?

To thrive as a Medical Claims Examiner, you need solid knowledge of medical terminology, insurance policies, and claims processing, typically backed by a high school diploma or associate degree in a related field. Familiarity with claims management software, ICD/CPT coding systems, and sometimes certification such as Certified Professional Coder (CPC) is highly valuable. Attention to detail, analytical thinking, and strong communication skills set top performers apart in this role. These competencies ensure accurate claim assessments, minimize errors, and facilitate effective resolution of insurance claims.

What are some common challenges faced by medical claims examiners in ensuring claim accuracy and compliance?

Medical Claims Examiners often face challenges such as deciphering complex medical records, keeping up with frequently changing insurance regulations, and ensuring all claims meet compliance standards. They must carefully review documentation to identify discrepancies or incomplete information, which requires a keen eye for detail and a strong understanding of medical terminology and coding. Additionally, balancing productivity quotas with accuracy and resolving disputes with providers or policyholders can be demanding, but these skills are highly valued and can lead to advancement opportunities in the field.

What is the difference between Medical Claims Examiner vs Medical Billing Specialist?

AspectMedical Claims ExaminerMedical Billing Specialist
Required CredentialsHigh school diploma; certifications like CPC or CCSHigh school diploma; certifications like CPC or CPC-A
Work EnvironmentInsurance companies, healthcare facilities, government agenciesMedical offices, clinics, healthcare providers
Employer & Industry UsagePrimarily in insurance and healthcare reimbursementIn healthcare revenue cycle management
Common Search & ComparisonYesYes

The Medical Claims Examiner reviews and processes insurance claims to ensure accuracy and compliance, often working within insurance companies or healthcare organizations. The Medical Billing Specialist focuses on generating and submitting billing statements to patients and insurers, managing the revenue cycle. While both roles require similar certifications and work in healthcare settings, Claims Examiners focus on claim review, whereas Billing Specialists handle billing and payments.

How much do medical claims examiners make in the US?

Medical claims examiners in the US typically earn a median annual salary of around $45,000 to $55,000. Salaries can vary based on experience, location, and employer, with some earning over $70,000 with advanced skills or certifications. The role often requires attention to detail and familiarity with insurance policies and claims processing systems.

How to become a medical claims examiner?

To become a medical claims examiner, typically one needs a high school diploma or equivalent, with many employers preferring postsecondary education or certification in health insurance or medical billing. Relevant skills include attention to detail, knowledge of medical terminology, and familiarity with claims processing software; some roles may require certification such as the Certified Medical Claims Examiner (CMCE).
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For Medical Claims Examiner jobs, the most frequently searched job titles are:

Medical Claims Examiner jobs near you
Infographic showing various Medical Claims Examiner job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 14% Part Time, and 6% Contract. Highlights an 87% Physical, 1% Hybrid, and 12% Remote job distribution, with an average salary of $43,917 per year, or $21.1 per hour.

Claims Examiner

Auxiant

Cedar Rapids, IA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 8 days ago

Job description

Job Type
Full-time
Description
https://www.auxiant.com/
Auxiant's Mission Statement and Core Values
Mission:
An Independent TPA investing in People and Innovation to deliver expert-driven experiences with REAL Results.
Core Values: Independent Solutions. REAL Results
Respect
Empowerment
Agility
Leadership
Be part of a growing and prospering company as a Claims Examiner. Auxiant is a third party administrator of self-funded employee benefit plans with offices in Cedar Rapids, IA, Madison and Milwaukee, WI. Auxiant is a fast-growing,progressive company offering an excellent wage and benefit package.
Job Summary: Responsible for processing medical claims and correspondence and handling customer service calls from members, providers, and clients.
Essential Functions:
  • Process claims in a timely manner with acceptable accuracy
  • Answer inbound phone calls from members and providers.
  • Handle correspondence from members and providers in a timely manner.
  • Analyze self-funded health plans and use plan language to correspond to necessary inquiries, both verbally and written.
  • Interpret plan design and language to analyze claim edits.
  • Point of contact for clients and members.
  • Work Customer Service Tickets.

Nonessential Functions:
  • Other duties as assigned or appropriate

Education/Qualifications:
  • Familiarity with ICD-10 and CPT coding
  • Understanding of medical claims processing guidelines
  • Proficient PC skills including email, record keeping, routine database activity, word processing, spreadsheet and 10-key
  • QicLink experience
  • Medical Terminology
  • High school diploma and 1-2 years related experience; or equivalent combination of education and experience

*Full benefits including: Medical, Dental, Vision, Flexible Spending, Gym Membership Reimbursement, Life Insurance, LTD, STD, 401K, 3 weeks vacation, 9 paid holidays, casual dress code and more
Job Type: Full-time
Schedule:
  • 8 hour shift
  • Day shift
  • Monday to Friday

Work Location: In person

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