How to hire a medical claims examiner

How to hire a medical claims examiner, step by step

Here's a step-by-step medical claims examiner hiring guide:

• Step 1: Identify your hiring needs
• Step 2: Create an ideal candidate profile
• Step 3: Make a budget
• Step 4: Write a medical claims examiner job description
• Step 5: Post your job
• Step 6: Interview candidates
• Step 7: Send a job offer and onboard your new medical claims examiner
• Step 8: Go through the hiring process checklist

What does a medical claims examiner do?

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1. Identify your hiring needs

   Before you post your medical claims examiner job, you should take the time to determine what type of worker your business needs. While certain jobs definitely require a full-time employee, it's sometimes better to find a medical claims examiner for hire on a part-time basis or as a contractor.

   Determine employee vs contractor status

   Is the person you're thinking of hiring a US citizen or green card holder?

   Yes

   No

   You should also consider the ideal background you'd like them a medical claims examiner to have before you start to hire. For example, what industry or field would you like them to have experience in, what level of seniority or education does the job require, and how much it'll cost to hire a medical claims examiner that fits the bill.

   This list shows salaries for various types of medical claims examiners.

   Type of Medical Claims Examiner	Description	Hourly rate
   Medical Claims Examiner	Claims adjusters, appraisers, examiners, and investigators evaluate insurance claims. They decide whether an insurance company must pay a claim, and if so, how much... Show more	$14-28
   Adjuster	An adjuster is responsible for evaluating the extent of loss in the company by calculating the damage costs, determining the settlement payment to the client, and managing the reputation of the company for claims accountability. Adjusters must have extensive knowledge of the insurance principles and processes, following the state and federal regulations to protect clients and the business from insurance fraud... Show more	$16-32
   Appraiser	An appraiser is someone who assesses the monetary value of a property such as an automobile, real property, and personal claim. His/Her or her responsibilities include resolving disparities between a property's monetary values and preparing narrative reports for projects... Show more	$13-28

   Show more

2. Create an ideal candidate profile

   Common skills:

   • Medical Terminology
   • Customer Service
   • Data Entry
   • Medical Treatment
   • Computer System
   • Provider Contracts
   • Medicaid
   • CPT-4
   • Process Claims
   • ICD-9
   • CMS
   • Denial Letters
   • HIPAA
   • HCPCS

   Check all skills

   Responsibilities:

   • Manage cases by aggressively directing the litigation process.
   • Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
   • Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
   • Identify which claims are eligible for PPO reprising.
   • Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
   • Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

   More medical claims examiner duties

3. Make a budget

   Including a salary range in your medical claims examiner job description helps attract top candidates to the position. A medical claims examiner salary can be affected by several factors, such as geography, experience, seniority, certifications, and the prestige of the hiring company.

   For example, the average salary for a medical claims examiner in North Dakota may be lower than in New Jersey, and an entry-level medical claims examiner usually earns less than a senior-level medical claims examiner. Additionally, a medical claims examiner with certifications may command a higher salary, and working for a well-known company or start-up may also impact an employee's pay.

   Average medical claims examiner salary

   $42,773yearly

   $20.56 hourly rate

   ---

   Entry-level medical claims examiner salary

   $30,000 yearly salary

   Updated January 23, 2026

   Average medical claims examiner salary by state

   Rank	State	Avg. salary	Hourly rate
   1	California	$51,420	$25
   2	New York	$48,313	$23
   3	Virginia	$48,063	$23
   4	Massachusetts	$47,264	$23
   5	Wisconsin	$46,318	$22
   6	Texas	$45,800	$22
   7	Georgia	$45,044	$22
   8	Indiana	$44,697	$21
   9	Illinois	$40,548	$19
   10	Maryland	$39,506	$19
   11	Oklahoma	$36,075	$17

   Average medical claims examiner salary by company

   Company

   Rank	Company	Average salary	Hourly rate	Job openings
   1	UST Global	$62,705	$30.15
   2	W. R. Berkley	$55,556	$26.71	35
   3	City of Baltimore	$52,993	$25.48
   4	Fojp Service Corporation	$49,770	$23.93
   5	University of Massachusetts Medical School	$49,085	$23.60
   6	BERKLEY TECHNOLOGY SERVICES	$48,552	$23.34	52
   7	International Medical Group	$47,314	$22.75
   8	Robert Half	$44,001	$21.15	10
   9	Randstad North America, Inc.	$43,734	$21.03	2
   10	MPI Home Care	$41,501	$19.95
   11	Texas Health Resources	$39,741	$19.11	1
   12	Kelly Services	$39,515	$19.00	6
   13	Nexus Staffing Solutions	$39,281	$18.89
   14	CornerStone Staffing	$38,393	$18.46
   15	The Reserves Network	$37,541	$18.05	1
   16	Texas Children's Hospital	$34,330	$16.50	2

4. Writing a medical claims examiner job description

   A medical claims examiner job description should include a summary of the role, required skills, and a list of responsibilities. It's also good to include a salary range and the first name of the hiring manager. Below, you can find an example of a medical claims examiner job description:

   Medical claims examiner job description example

   The 'Apply with SEEK' option will be utilized for International applicants, mainly Australia. If this does not apply to you please use the 'Apply' option.
   Claims Examiner - Medical Only
   
   IF YOU CARE, THERE'S A PLACE FOR YOU HERE
   
   For a career path that is both challenging and rewarding, join Sedgwick's talented team of 27,000 colleagues around the globe. Sedgwick is a leading provider of technology-enabled risk, benefits and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. Whether they have a workplace injury, suffer property or financial loss or damage from a natural or manmade disaster, are involved in an auto or other type of accident, or need time away from work for the birth of a child or another medical situation, we are here to provide compassionate care and expert guidance. Our clients depend on our talented colleagues to take care of their most valuable assets-their employees, their customers and their property. At Sedgwick, caring counts®. Join our team of creative and caring people of all backgrounds, and help us make a difference in the lives of others.
   
   For more than 50 years, Sedgwick has been helping employers answer virtually every question there is about workers' compensation. We have experience in nearly every type of industry and region and provide the industry's broadest range of programs and services.
   
   PRIMARY PURPOSE : To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices.
   
   ESSENTIAL FUNCTIONS and RESPONSIBILITIES
   Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Supports other claims representatives, examiners and leads with larger or more complex claims as necessary. Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency. Communicates claim action/processing with claimant, client and appropriate medical contact. Ensures claim files are properly documented and claims coding is correct. May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims. Maintains professional client relationships.
   ADDITIONAL FUNCTIONS and RESPONSIBILITIES
   Performs other duties as assigned. Supports the organization's quality program(s).
   QUALIFICATION
   
   Education & Licensing
   High school diploma or GED required. Licenses as required.
   
   Experience
   One (1) year of general office experience or equivalent combination of education and experience required. Claims industry experience preferred.
   
   Skills & Knowledge
   Excellent oral and written communication skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies
   WORK ENVIRONMENT
   When applicable and appropriate, consideration will be given to reasonable accommodations.
   
   Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
   
   Physical: Computer keyboarding, travel as required
   
   Auditory/Visual: Hearing, vision and talking
   
   NOTE : Credit security clearance, confirmed via a background credit check, is required for this position.
   
   The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
   
   Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

   Copy this example

   

5. Post your job

   There are a few common ways to find medical claims examiners for your business:

   • Promoting internally or recruiting from your existing workforce.
   • Ask for referrals from friends, family members, and current employees.
   • Attend job fairs at local colleges to meet candidates with the right educational background.
   • Use social media platforms like LinkedIn, Facebook, and Twitter to recruit passive job-seekers.

   Post your job online:

   • Post your medical claims examiner job on Zippia to find and recruit medical claims examiner candidates who meet your exact specifications.
   • Use field-specific websites.
   • Post a job on free websites.

6. Interview candidates

   To successfully recruit medical claims examiners, your first interview needs to engage with candidates to learn about their interest in the role and experience in the field. You can go into more detail about the company, the role, and the responsibilities during follow-up interviews.

   You should also ask about candidates' unique skills and talents to see if they match the ideal candidate profile you developed earlier. Candidates good enough for the next step can complete the technical interview.

   The right interview questions can help you assess a candidate's hard skills, behavioral intelligence, and soft skills.

7. Send a job offer and onboard your new medical claims examiner

   Once you've decided on a perfect medical claims examiner candidate, it's time to write an offer letter. In addition to salary, it should include benefits and perks available to the employee. Qualified candidates may be considered for other positions, so make sure your offer is competitive. Candidates may wish to negotiate. Once you've settled on the details, formalize your agreement with a contract.

   It's also important to follow up with applicants who do not get the job with an email letting them know that the position is filled.

   To prepare for the new employee's start date, you can create an onboarding schedule and complete any necessary paperwork, such as employee action forms and onboarding documents like I-9 forms, benefits enrollment, and federal and state tax forms. Human Resources should also ensure that a new employee file is created.

8. Go through the hiring process checklist

   • Determine employee type (full-time, part-time, contractor, etc.)
   • Submit a job requisition form to the HR department
   • Define job responsibilities and requirements
   • Establish budget and timeline
   • Determine hiring decision makers for the role
   • Write job description
   • Post job on job boards, company website, etc.
   • Promote the job internally
   • Process applications through applicant tracking system
   • Review resumes and cover letters
   • Shortlist candidates for screening
   • Hold phone/virtual interview screening with first round of candidates
   • Conduct in-person interviews with top candidates from first round
   • Score candidates based on weighted criteria (e.g., experience, education, background, cultural fit, skill set, etc.)
   • Conduct background checks on top candidates
   • Check references of top candidates
   • Consult with HR and hiring decision makers on job offer specifics
   • Extend offer to top candidate(s)
   • Receive formal job offer acceptance and signed employment contract
   • Inform other candidates that the position has been filled
   • Set and communicate onboarding schedule to new hire(s)
   • Complete new hire paperwork (i9, benefits enrollment, tax forms, etc.)

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How much does it cost to hire a medical claims examiner?