Medical Claims Specialist: Career and Salary Facts

<p>Medical claims specialists review healthcare-related insurance claims to determine if payments are due. You may work with patients and healthcare professionals to obtain complete and correct information. These professionals are also responsible for ensuring that both adjusters and claimants are complying with guidelines. Medical claims specialists determine if particular medical procedures are covered under a certain policy, and make sure that the procedure is necessary for the patient. They must often follow up to ensure that the procedure took place and the claim is not fraudulent. Sometimes medical claims specialists have to deny claims and explain the reasoning behind the denial. Learn more about this career option from the table below: </p> <p /> <table border="1"><tr><td><b>Degree Required</b></td><td> H.S. diploma or G.E.D.<br /> postsecondary training may be helpful</td></tr> <tr><td><b>Education Field of Study</b></td><td> Healthcare-related field</td></tr> <tr><td><b>Key Responsibilities</b></td><td> Evaluate insurance policies to determine coverage<br />Assist patient in filing claims<br />Contact patients and healthcare providers to clarify information</td></tr> <tr><td><b>Licensure/Certification</b></td><td> Certification is available</td></tr> <tr><td><b>Job Growth (2020-2030)*</b></td><td>-3% (for all claims adjusters, examiners and investigators)</td></tr> <tr><td><b>Mean Salary (2020)*</b></td><td>$70,650 (for all claims adjusters, examiners and investigators)</td></tr> </table><p><i>Source:*U.S. Bureau of Labor Statistics</i> </p> <h3 id="section---WhatKindOfDegreeDoINeedToBecomeAMedicalClaimsSpecialist">What Kind of Degree Do I Need to Become a Medical Claims Specialist?</h3> <p>Specialists generally need at least a high school degree, as well 1-2 years of experience in medical billing and or claims, as evident from a December 2011 search for medical claims specialist postings on <i>Monster.com</i>. Some training may be provided on the job, particularly on specialized software systems. You will need to keep up-to-date with changes in state and federal laws, insurance coverage and medical procedures. </p> <p>To advance in this field, you may consider completing a certified medical insurance specialist course. You will generally need knowledge on medical records and coding, through professional experience or by completing coursework. Courses are available both online and through community colleges, and will cover topics similar to the following: </p> <ul><li>Insurance billing and coding </li><li>Office procedures </li><li>Medical terminology </li><li>Regulation compliance </li><li>Composition principles </li></ul><h3 id="section---WhatWillIDo">What Will I Do?</h3> <p>Employers generally look for applicants who are organized and able to multi-task. Strong communication and interpersonal skills may also be necessary. Working as a medical claims specialist, you will handle all phases of a claim, including gathering reports, investigating and correcting any issues, collecting payments, determining coverage and closing files. </p> <p>During the life of a claim, you may work with the patient and any medical personnel to obtain complete and correct information. You will also need to ensure that all legal and company guidelines are followed in the handling of a claim. If there is conflict over the claim, you may need to work with the attorneys who handle your firm's legal work. </p> <h3 id="section---HowMuchWillIEarn">How Much Will I Earn?</h3> <p>In May 2020, the U.S. Bureau of Labor Statistics reported that the mean salary for claims adjusters, examiners and investigators was $70,650. The projected growth rate from 2020 to 2030 for these professionals declined by -3%. More claims can be handled by automated systems although personal oversight will always be needed. The number of healthcare claims is expected to increase as the population ages. Most medical claims specialists work a 40-hour week for health care providers or insurance or medical billing companies. </p> <h3 id="section---WhatAreSomeRelatedAlternativeCareers">What Are Some Related Alternative Careers?</h3> <p>Automotive body and glass repairers and construction and building inspectors are some related positions that require a high school diploma or equivalent. Automotive body and glass repairers work to repair various aspects of damaged vehicles. This may include replacing windshields or door frames. Construction and building inspectors examine structures to ensure compliance with various building codes. They may also check for zoning requirements.</p>