Medical claims examiner vs examiner

The differences between medical claims examiners and examiners can be seen in a few details. Each job has different responsibilities and duties. Additionally, an examiner has an average salary of $46,323, which is higher than the $42,773 average annual salary of a medical claims examiner.

The top three skills for a medical claims examiner include medical terminology, customer service and data entry. The most important skills for an examiner are customer service, vital signs, and phlebotomy.

Medical claims examiner vs examiner overview

	Medical Claims Examiner	Examiner
Yearly salary	$42,773	$46,323
Hourly rate	$20.56	$22.27
Growth rate	-6%	-6%
Number of jobs	57,125	6,901
Job satisfaction	5	-
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 51%
Average age	44	46
Years of experience	6	-

What does a medical claims examiner do?

A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to. They are also tasked with approving payment and facilitating additional investigation. Qualifications for this position include knowledge of medical terminology.

What does an examiner do?

An examiner is responsible for evaluating loan property and documents, assessing the property's value, and issuing a clear sale title upon ensuring no restrictions to the property. Examiners coordinate with banks, realty institutions, and other agencies to determine the property's status before proceeding with its sales release. They must be highly-knowledgeable with the real property disciplines and evaluation processes to perform the duty with utmost accuracy and efficiency. An examiner must also have excellent communication and analytical skills and adhering to federal laws and regulations.

Medical claims examiner vs examiner salary

Medical claims examiners and examiners have different pay scales, as shown below.

	Medical Claims Examiner	Examiner
Average salary	$42,773	$46,323
Salary range	Between $30,000 And $59,000	Between $30,000 And $70,000
Highest paying City	Los Angeles, CA	San Francisco, CA
Highest paying state	New Jersey	Connecticut
Best paying company	UST Global	CME Group
Best paying industry	Technology	Retail

Differences between medical claims examiner and examiner education

There are a few differences between a medical claims examiner and an examiner in terms of educational background:

	Medical Claims Examiner	Examiner
Most common degree	Bachelor's Degree, 36%	Bachelor's Degree, 51%
Most common major	Business	Business
Most common college	University of Pennsylvania	-

Medical claims examiner vs examiner demographics

Here are the differences between medical claims examiners' and examiners' demographics:

	Medical Claims Examiner	Examiner
Average age	44	46
Gender ratio	Male, 16.6% Female, 83.4%	Male, 36.6% Female, 63.4%
Race ratio	Black or African American, 10.5% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.4% American Indian and Alaska Native, 0.5%	Black or African American, 11.8% Unknown, 4.5% Hispanic or Latino, 15.5% Asian, 8.2% White, 59.2% American Indian and Alaska Native, 0.8%
LGBT Percentage	10%	12%

Differences between medical claims examiner and examiner duties and responsibilities

Medical claims examiner example 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.

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Examiner example responsibilities.

Manage country wide litigate and non-litigate claims for TPA construction program.
Manage Kemper's internal loss control and claims for all Kemper employees and offices.
Manage complex and significantly consequential litigation as well as sensitive cases involving catastrophic injuries and fatality.
Manage litigation costs (defense/consultants/independent investigators/experts).
Engage in mediation, arbitration hearings, discovery proceedings, settlement conferences, and trials.
Draw blood, collect urine, run EKG'S and collect medical history on clients to obtain life insurance policies.

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Medical claims examiner vs examiner skills

Common medical claims examiner skills

Medical Terminology, 10%
Customer Service, 9%
Data Entry, 7%
Medical Treatment, 5%
Computer System, 5%
Provider Contracts, 4%

Common examiner skills

Customer Service, 12%
Vital Signs, 9%
Phlebotomy, 8%
Blood Draws, 7%
Physical Exams, 7%
Medical Terminology, 6%

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Updated January 8, 2025

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