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Coroners in the United States are usually county-level officers, are often elected (rather than appointed) officials, and usually do not need to hold any medical qualification. As finders of fact, they retain quasi-judicial powers such as the power of subpoena, and in some states they also have the power to impanel juries of inquest, but unlike their British equivalents, they are not judicial officers, instead considered to be executive branch officials.

In some states the coroner and the sheriff are one and the same. In some counties, the coroner is the only person with the power to arrest the sheriff.

Many jurisdictions have replaced the elected coroner with a Medical Examiner (often referred to by the initials "M.E."), who must be a physician, and is most often a specialist in pathology or forensic medicine. In some jurisdictions, a medical examiner must be both a doctor and a lawyer.

The medical examiner is most often an appointed official. This has been part of a move toward professionalizing a job increasingly involved with advanced scientific techniques. In larger cities (for instance, New York City) and more populous counties, the post may be that of "chief medical examiner", heading an office with M.E.s and deputy M.E.s on staff to handle individual cases.

Other jurisdictions, such as Monterey County, California, have merged the legal competencies of a coroner into the office of the Sheriff, whose medical duties as coroner are then delegated to a professional forensic staff of medical examiners, technicians, and such.

Duties

Duties always include determining the cause, time, and manner of death. This uses the same investigatory skills of a police detective in most cases, because the answers are available from the circumstances, scene, and recent medical records. In many American jurisdictions any death not certified by the person's own physician must be referred to the medical examiner. If an individual dies outside of their state of residence, the coroner of the state in which the death took place issues the death certificate. Only a small percentage of deaths require an autopsy to determine the time, cause and manner of death.

In some states, additional functions are handled by the coroner. For example, in Louisiana, coroners are involved in determination of mental illness of living persons. In Georgia, the coroner has the same powers as a county sheriff to execute arrest warrants and serve process, and in certain situations where there is no sheriff (described in Title 15, Chapter 16, Section 8 of Georgia law), they officially act as sheriff for the county. In Kentucky, section 72.415 of the Kentucky Revised Statutes gives coroners and their deputies the full power and authority of peace officers. This includes the power of arrest and the authority to carry firearms.