Medical Claims Examiner Jobs in Texas
Medical Claims Examiner jobs in Texas are concentrated in insurance carriers, large health systems, and third-party administrators, with demand at every level from entry-level processors to senior examiners handling complex liability cases. The heaviest hiring activity is in Houston, Dallas, and San Antonio, where anchors like UnitedHealth Group, Blue Cross and Blue Shield of Texas, and Aetna maintain large operations. The most consistent openings are in medical billing review, workers' compensation adjudication, and Medicare or Medicaid claims processing. Scan the live roles below and apply to whichever ones fit.
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Senior Workers’ Compensation Claims Examiner (Texas Licensed)
We are seeking an experienced Workers’ Compensation Claims Examiner to join a collaborative claims team handling complex indemnity claims from initial investigation through resolution. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced environment and enjoys balancing analytical decision-making with strong client and claimant communication.
In this role, you will independently manage a caseload of approximately 110–150 workers’ compensation claims, including complex files requiring advanced investigation, compensability analysis, reserve management, and ongoing medical oversight. You will work closely with claimants, employers, medical providers, attorneys, and internal stakeholders to ensure timely and compliant claim resolution in accordance with Texas workers’ compensation regulations.
Key Responsibilities:
Investigate and manage workers’ compensation claims from inception to closure
Determine compensability and administer benefits in accordance with state laws and company guidelines
Coordinate medical treatment and manage related billing activity
Establish and maintain accurate claim reserves
Maintain organized documentation and diary management for all claim activity
Communicate effectively with clients regarding claim status, trends, and risk concerns
Conduct independent file reviews and proactively drive claims toward resolution
Qualifications:
Active Texas Workers’ Compensation Adjuster License required
5+ years of workers’ compensation claims handling experience, including complex indemnity claims
Strong understanding of workers’ compensation statutes, medical terminology, and claims investigation
Excellent written and verbal communication skills
Ability to manage a high-volume caseload independently
Proficiency with Microsoft Office applications preferred
This position offers the opportunity to join a professional, team-oriented environment where your expertise and judgment will have a direct impact on claim outcomes and client satisfaction.
#WorkwolfSenior Workers’ Compensation Claims Examiner (Texas Licensed)
We are seeking an experienced Workers’ Compensation Claims Examiner to join a collaborative claims team handling complex indemnity claims from initial investigation through resolution. This is an excellent opportunity for a detail-oriented professional who thrives in a fast-paced environment and enjoys balancing analytical decision-making with strong client and claimant communication.
In this role, you will independently manage a caseload of approximately 110–150 workers’ compensation claims, including complex files requiring advanced investigation, compensability analysis, reserve management, and ongoing medical oversight. You will work closely with claimants, employers, medical providers, attorneys, and internal stakeholders to ensure timely and compliant claim resolution in accordance with Texas workers’ compensation regulations.
Key Responsibilities:
Investigate and manage workers’ compensation claims from inception to closure
Determine compensability and administer benefits in accordance with state laws and company guidelines
Coordinate medical treatment and manage related billing activity
Establish and maintain accurate claim reserves
Maintain organized documentation and diary management for all claim activity
Communicate effectively with clients regarding claim status, trends, and risk concerns
Conduct independent file reviews and proactively drive claims toward resolution
Qualifications:
Active Texas Workers’ Compensation Adjuster License required
5+ years of workers’ compensation claims handling experience, including complex indemnity claims
Strong understanding of workers’ compensation statutes, medical terminology, and claims investigation
Excellent written and verbal communication skills
Ability to manage a high-volume caseload independently
Proficiency with Microsoft Office applications preferred
This position offers the opportunity to join a professional, team-oriented environment where your expertise and judgment will have a direct impact on claim outcomes and client satisfaction.
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Find Medical Claims Examiner JobsMedical Claims Examiner Jobs by City in Texas
Where Texas roles are concentrated, by current openings.
Medical Claims Examiner Job Market in Texas
A snapshot from current Texas openings, updated as new roles post.
Who's Hiring
What Texas Employers Look For
The qualifications that appear most often in medical claims examiner jobs across Texas.
- High school diploma or associate degree in healthcare administration or a related field
- Demonstrated working knowledge of ICD-10 and CPT medical coding systems
- Experience reviewing and adjudicating health, workers' compensation, or liability claims
- Proficiency with claims management platforms such as TriZetto Facets or Xcelys
- Strong knowledge of Texas Department of Insurance regulations and prompt-pay requirements
- Familiarity with Medicare and Medicaid claims processing guidelines and compliance standards
Medical Claims Examiner Jobs in Texas: Frequently Asked Questions
How do you become a medical claims examiner in Texas?
Texas does not require a state-issued license specifically for medical claims examiners, but most employers expect a high school diploma or associate degree in healthcare administration, medical billing, or a related field. Earning a nationally recognized credential such as the Certified Professional Coder from AAPC or the Certified Coding Associate from AHIMA significantly strengthens candidacy. Many Texas carriers and health systems also look for completion of an employer-sponsored claims training program before independent adjudication.
Which companies hire medical claims examiners in Texas?
Companies currently hiring medical claims examiners in Texas include TEEMA, TEEMA, and AIG Claims, per current listings on Migrate Mate as of September 2026. Texas's large concentration of insurance carriers, managed care organizations, and self-funded employer health plans means the pipeline of openings stays active across both the major metros and suburban processing centers.
Which Texas cities have the most medical claims examiner jobs?
Plano, Houston, and Dallas consistently post the most medical claims examiner openings in Texas. Houston's size as a national insurance and energy hub drives the largest share of those listings, while Dallas anchors a dense corridor of carrier headquarters and third-party administrators, and San Antonio's concentration of military health benefit contractors and TRICARE processors keeps that market active year-round.
Are there remote medical claims examiner jobs in Texas?
Yes, and more than most fields. Medical claims examination is a desk-based analytical role that translates well to remote work, since adjudication, documentation review, and system entry require no physical presence. About 75% of medical claims examiner openings tied to Texas are remote or hybrid as of September 2026, reflecting how broadly carriers and third-party administrators have adopted distributed teams. Complex liability and audit review roles tend to carry the highest proportion of fully remote postings.
How can I get hired as a medical claims examiner in Texas with little or no experience?
The most realistic entry path is through a claims processor or medical billing specialist role at a Texas health system or regional insurer, where on-the-job training covers adjudication fundamentals. Large Texas employers such as Blue Cross and Blue Shield of Texas and UnitedHealth Group run structured onboarding programs that bring in candidates with only a healthcare administration certificate or coursework. Completing an ICD-10 and CPT coding course through AAPC or a community college like Austin Community College or Houston Community College, then applying to entry processor postings, is the clearest route without prior claims experience.
Where can I find and apply to medical claims examiner jobs in Texas?
You can find and apply to medical claims examiner jobs in Texas on Migrate Mate, which lists current Texas openings updated in real time. Search the listings, identify roles that match your experience level and preferred location or work arrangement, and apply directly to the ones that fit.
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