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How to Become a Medical Claims Examiner

Duties, Responsibilities, Schooling, Requirements, Certifications, Job Outlook, and Salary

Woman filling out life insurance forms

There is a variety of alternative healthcare career opportunities available for those who have earned their Medical Assistant diploma. The organizations that offer these careers place a great deal of importance on the knowledge and skills you’ve acquired during your education. One fulfilling alternative job you can apply for is to become a medical claims examiner. For MAs looking for a career outside of the traditional medical setting, a job as a medical claims examiner can be a tremendously rewarding option. Not only will it enable you to build on your medical background, but becoming a medical claims examiner can also provide a long-term source of stable income.

Continue reading this career guide for an in-depth look at the skills involved in being a medical claims examiner, along with the educational requirements, salary*, and job outlook for this important position.

Not sure if becoming a medical claims examiner is right for you? Click here to see the other careers featured on our list of top alternative jobs for medical assistants.

Medical Claims Examiner Definition

What is a Medical Claims Examiner?

Medical claims examiners work with medical insurance customers to review insurance claims, determine adherence to standard guidelines, ensure the timeliness of claims processing, and make sure that the integrity of the information is accurate and kept private.

Medical Claims Examiner: Job Description

What Does a Medical Claims Examiner Do?

Most medical claims examiners work on behalf of insurance companies to determine whether medical claims made by customers are covered under their policy. When reviewing claims, a medical claims examiner follows strict, standardized guidelines while entering claim information and when validating that information’s integrity. Based on their findings, medical claims examiners must decide whether claims are accepted or denied in a timely manner so that insured patients, as well as doctors and hospitals, can receive claim reimbursements.

Medical Claims Examiner Duties

Some of the day-to-day responsibilities of medical claims examiners include:

  • Entering the data for insurance claims
  • Ensuring information integrity
  • Following strict guidelines
  • Approving or denying claims payments
  • Facilitating additional investigation as needed
  • Providing assistance to claims adjusters
  • Ensuring legal compliance

Where Do Medical Claims Examiners Work?

Medical claims examiners work in office environments and are most often employed by health insurance companies or life insurance companies, while others also work in the administrative offices of hospitals.

Medical Claims Examiner Schooling & Certification

How Long Does It Take to Become a Medical Claims Examiner?

What Degree Do You Need to Be a Medical Claims Examiner?

If you’re a Medical Assistant interested in taking your career in a different direction while remaining within the medical industry, you will find that you are already well-aligned to make the switch to becoming a medical claims examiner. While some employers may require only a high school diploma or its equivalent, many employers prefer candidates who already possess diplomas or degrees related to the medical field.

Insurance companies and hospitals require medical claims adjusters to follow strict guidelines, and they’ll provide specific training for the candidates they hire. The knowledge you’ve gained during your education as a medical assistant and your thorough understanding of the larger medical field will be highly valued by employers when applying for the position.

Healthcare worker making a heart with their hands

Why is Medical Claims Examiner a Great Alternative Career Path for Medical Assistants?

When insurance companies hire health claims examiners, most highly qualified candidates come with either insurance or medical backgrounds. Prospective employers will highly value the knowledge of medical terminology you’ve gained as an MA and your overall familiarization with the medical field. Candidates should also be detail-oriented people who possess strong administrative skills.

Medical assistants making the jump to medical claims examiners will take satisfaction in knowing that they’re still working for the patients benefit. Insurance examiners play an essential role in helping people get back to good health while also protecting their financial interests with fair and honest insurance coverage.

Medical Claims Examiner Salary

How Much Do Medical Claims Examiners Make?

Although the U.S. Bureau of Labor Statistics (BLS) does not report specific salary* data for medical claims examiners, they do report on the salary* data for claims adjusters. The BLS reports the average annual salary* for claims adjusters is about $69,000, with an hourly wage of about $33 per hour. Those who rise to earn in the 90th percentile of claims adjusters can earn an annual salary* of about $100,000 per year, or an hourly wage of about $48 per hour, or more.

Highest Paying Industries for Medical Claims Examiners

According to the BLS, these industries are where you’re most likely to find the top-paying jobs for claims adjusters:

Industry Average Hourly Pay Average Salary
Medical & Diagnostic Laboratories $38.48 $80,040
Insurance & Employee Benefits $33.61 $69,910
Insurance Carriers $33.52 $69,720
Agencies, Brokerages, and Other Insurance Related Activities $33.11 $68,860

Highest Paying States for Medical Claims Examiners

According to the BLS, claims adjusters earn the highest average wages in the following states:

State Average Hourly Pay Average Salary
Washington D.C. $43.19 $89,830
New Jersey $41.70 $86,730
Connecticut $39.33 $81,800
California $38.26 $79,570
Massachusetts $37.55 $78,100

Highest Paying Cities for Medical Claims Examiners

According to the BLS, claims adjusters earn the highest annual wages in the following cities:

City Average Hourly Pay Average Salary
Bridgeport, CT $47.11 $97,980
Waterbury, CT $44.31 $92,160
San Francisco, CA $42.67 $88,750
Salinas, CA $42.61 $88,620
Texarkana, TX/AR $42.60 $88,610
Charleston, SC $42.42 $88,230
New Bedford, MA $42.41 $88,220
Sheboygan, WI $41.32 $85,950
Atlantic City, NJ $40.88 $85,030
Barnstable Town, MA $40.85 $84,970

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Start Your Career by Earning Your Medical Assistant Diploma

If you’re someone looking for a rewarding career in a healthcare-related field, who is a stickler for detail and has excellent administrative skills, becoming a medical claims examiner could be a great career path for you.

If you’re ready to take the next step towards becoming a medical claims examiner, you can start by earning your Medical Assistant diploma in as little as 10 months at Eagle Gate College.

Click here to learn more about our Medical Assistant program.