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Medical Claims Processor: Job Description, Duties and Requirements

A career as a medical claims processor requires little formal education, though the job demands a working knowledge of the health insurance industry. Learn about the training, job duties, and certification to see if this is the right career for you.

Medical claims processors manage insurance claims in medical offices where they are responsible for determining the validity of a claim. While there is no official educational requirement for this position, many hold at least a high school diploma or equivalent and seek out optional certification.

Essential Information

A medical claims processor manages insurance claims from patients in doctors' offices and insurance companies. It is the job of the claims processor to analyze and process the insurance claim, checking it for validity. Medical claims processors are not required to have any formal education, but some training courses may help them obtain voluntary certification.

Required Education High school diploma or equivalent
Other Requirements On-the-job training; voluntary certification available
Projected Job Growth (2014-2024)* 6% (for insurance claims and policy processing clerks)
Median Salary (2015)* $37,530 (for insurance claims and policy processing clerks)

Source: *U.S. Bureau of Labor Statistics

Job Duties of a Medical Claims Processor

A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.

Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer. Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents. Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.

Requirements of a Medical Claims Processor

Education Requirements for a Medical Claims Processor

There are no set educational requirements for medical claims processors. Companies may provide on-the-job training, though some previous knowledge or courses in the field may be required to enter the profession. Some schools offer vocational training or certificate programs for claims processing, which may help to start or advance a career.

It is strongly recommended that potential medical claims processors take the Certified Medical Reimbursement Specialist (CMRS) exam. According to the American Medical Billing Association, certification exhibits a dedication to professional development and aptitude in the skills necessary to succeed as a medical claims processor. The CMRS exam tests areas such as medical terminology, knowledge of medical fraud, and medical billing codes (www.ambanet.net).

Career Requirements for a Medical Claims Processor

Medical claims processing is often an entry-level position that includes on-the-job training. However, it is beneficial to have proven customer service and computer experience. Those with a previous medical background may increase their job opportunities.

Salary Info and Job Outlook

The U.S. Bureau of Labor Statistics (www.bls.gov) reported that in May, 2015 the median annual salary of insurance claims and policy processing clerks was $37,530. It is expected that employment will grow by 6% during the 2014-2024 decade.

Medical claims processors must be organized and thorough and have strong communication skills. If you have these qualities and are interested in working in the healthcare industry, this could be the career for you.

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