Health Claims Examiner

Health claims examiners often work for health insurance companies, and they're primarily responsible for reviewing medical claims. Read on to learn more about this career.

Is Health Claims Examining for Me?

Career Description

Working as a health claims examiner, you would provide many services to the health industry. You would interpret dental, medical and hospital claim forms, process insurance claims, analyze costs and coordinate benefits. You should be meticulous, possess good communication skills and have basic keyboarding skills.

Examining health claims, you might work as a medical claims examiner, medical billing specialist or medical insurance specialist. You might work in physicians' offices, medical clinics, dentists' practices, insurance firms or billing agencies. Many work for medical insurance firms. Working in such a firm, you can expect to have a typical work schedule of 40 hours per week.

Employment Information

According to the U.S. Bureau of Labor Statistics (BLS), employment of claims adjusters, appraisers, examiners and investigators was expected to increase four percent from 2012-2022, which is considered to be slower than average (www.bls.gov). The BLS noted job prospects were better with health insurance firms. In May 2013, the BLS also reported that claims adjusters, examiners and investigators earned an average annual salary of $62,340.

How Can I Become a Health Claims Examiner?

Training

Though there isn't any official educational requirements to become a claims examiner, employers do like to see applicants who have completed a formal training program. Prior experience in typing, computers and customer support can provide groundwork when entering a program in health claims examining.

Academic programs for aspiring health claims examiners are offered primarily through junior colleges. You could enroll in a medical claims examiner program or a medical billing specialist program. These types of programs are commonly lead to undergraduate certificates. Online medical billing programs might also be available. Courses might include composition and structure of the human body, medical terms, data entry and legal and insurance procedures.

As a graduate of a medical claims examiner or medical billing specialist program, you will be familiar with health terms and the human body. You will be proficient in word processing, be able to operate software programs, accurately process claims and efficiently interact with those involved in health claims. You will be familiar with policies, rules and regulations concerning healthcare, be able to troubleshoot problems and make certain claims conform to standards.

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