Health Claims Specialist: Job Description & Requirements

Health claimes specialists require some formal education. Learn about the training, job duties, and requirements to see if this is the right career for you.

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Essential Information

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 just a high school diploma, but some call for more advanced education through a certificate program in medical billing technology or a relevant field.

Individuals in these jobs need good customer service and communications skills, as well as knowledge of computer software, medical insurance coding, and insurance and medical terminology. Professional certification in this field is not mandatory, but could boost career advancement.

Required Education High school diploma or GED certificate sufficient for some jobs, while others require a certificate in medical billing technology
Projected Job Growth (2012-2022)*22% (medical records and health information technicians)
Median Salary (2013)* $34,970 (medical records and health information technicians)

Source: *U.S. Bureau of Labor Statistics (BLS).

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.

Requirements

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.

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 U.S. Bureau of Labor Statistics (BLS), employment of medical records and health information technicians, including health claims specialists, is expected to grow by 22% between 2012 and 2022 (www.bls.gov). The BLS also reported the median annual salary earned by such specialists as $34,970 in May 2013.

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