Health Claims Specialist: Job Description & Requirements

Health claims specialists process medical insurance claims and resolve billing issues. They often work for insurance companies, health care providers, and hospitals. Many employers require a high school diploma and experience in the health care or insurance industries, but some might need more advanced education.

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Health Claims Specialist Job Description

Health claims specialists gather and process information needed to complete medical insurance claims. They do much of their work on the telephone, taking inbound customer-service calls and making outbound calls to patients and health care providers. In addition to processing routine claims, they investigate pending claims and resolve discrepancies. They can work in call centers of health maintenance organizations (HMOs) as well as insurance companies, physician's offices, and hospital billing departments.

Health Claims Specialist Requirements

Education

Entry-level jobs in health claims generally require a high school diploma, but employers could prefer applicants with an education in health information technology or medical billing. Some vocational schools and community colleges offer certificate programs specifically for health claims specialists, with coursework in medical terminology, transcription, billing, and coding. Employers might also favor applicants who have experience in medical billing, previous employment in the insurance industry, or professional certification.

Certification

Professional certification in coding or medical information technology might increase a health claims specialist's chances of finding employment or advancing in his or her career. The American Health Information Management Association (AHIMA) offers various credentials in this area, including several insurance coding certifications and the Registered Health Information Technician (RHIT) credential (www.ahima.org). A candidate must earn an associate's degree from a program accredited by the Commission on Accreditation for Health Informatics and Information Management Education to qualify for the RHIT certification exam.

Required Skills

Health claims specialists must have good customer-service, data-entry, word-processing, and phone skills. They also need a working knowledge of claims-payment laws as well as medical terminology. Additionally, these specialists must be familiar with diagnostic coding systems and coding procedures.

Salary Info and Job Outlook

According to the Bureau of Labor Statistics (BLS, www.bls.gov), the employment of medical records and health information technicians, including health claims specialists, is expected to grow by 21% between 2010 and 2020. The BLS also reported the median annual salary earned by such specialists as $34,160 in May 2012.

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