How to Become a Health Claims Examiner: Step-by-Step Career Guide

Aug 11, 2018

Learn how to become a health claims examiner. Research the job description and education requirements, and explore how to start a career examining health claims.

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  • 0:00 Should I Become a…
  • 1:18 Step 1: Complete a…
  • 2:09 Step 2: Obtain a License
  • 2:44 Step 3: Seek Employment
  • 3:06 Step 4: Consider Certification
  • 3:27 Step 5: Continue Your…

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Should I Become a Health Claims Examiner?

Degree Level High school diploma or equivalent; technical/associate's degree may be preferred
Degree Field Health claims examiner, medical billing, health insurance specialist, or similar field
Licensure Required and varies by state
Experience 1-3 years related professional experience
Key Skills Excellent written and verbal communication, interpersonal, problem-solving, listening, comprehension and translation skills; familiarity with document management, data base reporting, insurance claims, financial analysis, and other related software
Salary $62,980 (2015 median for all insurance adjuster, examiners, and investigators)

Sources: U.S. Bureau of Labor Statistics (BLS); O*Net Online; Job postings from employers.

Health claims examiners investigate claims by medical insurance policyholders, review federal and state regulations, negotiate settlements and allow for payment distribution. These examiners, sometimes also called health claims adjustors, often work for health insurance companies and health maintenance organizations. Many of their work hours are spent seated at a desk.

Gaining entry into this career generally requires a high school diploma or equivalent, state licensure and 1 to 3 years of relevant experience. However, some employers prefer applicants with a degree related to the field. These professionals also need excellent written and verbal communication, interpersonal, problem-solving, listening, comprehension and translation skills. They should also be familiar with software needed for document management, database reporting, insurance claims and financial analysis.

Earnings for these workers vary by industry, but according to the U.S. Bureau of Labor Statistics, the median salary for all insurance adjusters, examiners and investigators was $62,980 as of May 2015. Now let's walk through the steps needed to become a health claims examiner.

Step 1: Complete a Degree Program

Although not required by all employers, completion of an associate's degree program can prepare you for a career as a health claims examiner. Some employers may favor applicants who hold a bachelor's degree. Community colleges, technical schools and universities offer relevant degree programs in health claims examination, medical billing and other fields related to health insurance.

During college you may benefiting from completing an internship. An internship will provide you with hands-on experience in the field and introduce you to contacts that may prove helpful in a future job search. Additionally, be sure to develop your communication and interpersonal skills. A strong aptitude for verbal and written communications is essential for this career, so you may want to take classes in speech and interpersonal communications and participate in school organizations and activities.

Step 2: Obtain a License

Licensure for health claims examiners is regulated on the state level. Although requirements vary, some states require coursework, fees, fingerprinting and an examination to obtain licensure. Additionally, health claims examiners typically complete continuing education to maintain licensure. However, before obtaining licensure, be sure to consult with the state licensing board. Some states allow examiners to forego licensure and work under the license of their employing company. The determining factor here is generally the type and size of the company you intend to work for.

Step 3: Seek Employment

Now that you're on your way to becoming licensed, it's time to find a position in the field. Generally, you'll want to seek entry-level positions in the field. After all, employers tend to require 1 to 3 years of experience when considering health claims examiners. New health claims examiners typically work for medical insurance companies and health maintenance organizations.

Step 4: Consider Certification

Although generally not mandatory, professional certification can help health claims examiners advance in the field. For instance, the American Institute for Chartered Property Casualty Underwriters offer the Associate in Claims designation. This certification requires completion of intermediate-level courses and passage of an examination.

Step 5: Continue Your Education

Health claims examiners must be knowledgeable in the most recent state and federal court decisions that impact claims, as well as current medical operations and the latest drugs. Some companies provide continuing education opportunities to their examiners. You may also find seminars and online continuing education classes through schools and professional organizations. Such courses may be applied to meeting continuing education requirements for licensure and certification.

While a high school diploma and professional licensure may suffice, a career as a health claims examiner often requires a relevant degree and 1 to 3 years of experience in the field.

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