What's the Job Description of a Medical Insurance Specialist?

Research what it takes to become a medical insurance specialist. Learn about education requirements, job duties, median wages and job outlook to find out if this is the career for you. Schools offering Insurance Billing & Coding Specialist degrees can also be found in these popular choices.

What Is a Medical Insurance Specialist?

Medical insurance specialists are responsible for activities related to the processing and documentation of health insurance claims. Job duties vary depending on the setting in which they work. The U.S. Bureau of Labor Statistics (BLS) reports that within an insurance or government setting, medical insurance specialists are usually referred to as claims examiners who assess the necessity of a medical procedure and approve or deny insurance coverage.

Alternatively, if you work in a medical office or facility, you could be a health information technician. Health information technicians organize patient data and input it into databases for insurance reimbursement purposes. They must make sure that the medical records they handle are accurate and that the database is secure.

Consider the information in the following table to determine if a career as a medical insurance specialist is the right career for you.

Medical Claims Examiner Health Information Technician
Degree Required High school diploma or equivalent for entry-level positions Certificate or associate's degree for most positions
Education Field of Study A medical background could be helpful Health information technology
Key Skills Analytical, communication, interpersonal, and math skills Analytical, technical and interpersonal skills, strong attention to detail
Licensure/Certification Required Varies state to state Certification often required by employers
Job Growth (2014-2024) 3% for all claims adjusters, examiners and investigators* 15% for all medical records and health information technicians*
Median Salary (2015) $62,980 for all claims adjusters, examiners and investigators* $37,110 for all medical records and health information technicians*

Source: *U.S. Bureau of Labor Statistics.

What Do Medical Claims Examiners Do?

In this role, your duties include reviewing incoming medical claims for payment or denial, as well as processing policy applications from prospective policyholders. You confirm and update benefits coverage and pre-approval for certain medical procedures, such as surgery. You need to know the latest insurance regulations, claims processing guidelines, medical terminology and procedure codes. Strong communication skills are essential; part of your job involves obtaining information from policyholders or medical staff in order to make a sound processing decision (www.bls.gov).

What Would My Job Be Like as a Health Information Technician?

In a medical office or facility, you might find work as a health information technician (HT). Your job includes calculating medical bills and preparing medical claims before processing the necessary paperwork, verifying insurance coverage and updating patient records as needed. As with claims examiners, the American Health Information Management Association (AHIMA) reports that you need to know which medical and disease or injury codes to use as well as the regulations and procedures to follow for prompt payment (www.ahima.org).

In addition to records management and billing and posting claims, your duties as a HT may also include greeting patients, scheduling appointments and filing. You may have more patient contact than if you were a claims examiner in an insurance or government agency.

Can I Specialize Within This Field?

The American Academy of Professional Coders (AAPC) reports that medical coders must have extensive knowledge of the latest alphanumeric codes that tells the insurance company or other payer what disease of injury is being treated as well as what procedure or treatment was performed (www.aapc.com). Medical coders may or may not actually process and send out claims; they often work for large companies that segregate job duties within the larger scope of claims processing. The AAPC offers a certification examination for professionals wishing to specialize in this area of the medical insurance field.

What's My Potential Salary?

The BLS reported that all claims adjusters, examiners and investigators earned a median salary of $62,980 in 2015. In that same year, the median wage for all medical records and health information technicians was $37,110.

What Are Some Related Alternative Careers?

Instead of working as a health information technician, you could consider another job in a medical office, such as a medical secretary. Secretaries perform clerical duties like scheduling appointments and sending bills to patients and insurance companies. The minimum educational requirement is a high school diploma, but completing a postsecondary training program may boost job prospects. If you would rather work at an insurance company, you could consider becoming an insurance claims and policy processing clerk. Your job would be to interview applicants, process application paperwork, make changes when requested and cancel policies for clients who no longer want them. For this job, you need at least a high school diploma.

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