How To Become A Claims Adjudicator: What It Is and Career Path

What is a claims adjudicator and how to become one

Updated January 8, 2025

4 min read

Claims adjudication is the process of paying or denying claims after they are evaluated. Claims adjudicators are the ones responsible for determining the amount of money that should be paid to the insurance policy owners, as well as deciding if the claim should be denied or negotiated.

The typical workflow of a claims adjudicator involves many reviews, namely the initial process review, automatic review, and manual review, which are then followed by payment determination and the payment itself. During this process, a claims adjudicator examines claim documents, investigates the claim, and reviews the policy of the insured before making a decision.

Typically, you need to have a bachelor's degree in accounting, human resources, or a similar field in order to qualify for this role. You may also need to have specialized training or experience in a specific area, such as in the case of health insurance claims adjudicators. Nevertheless, employers may hire fresh graduates for this entry-level role, given that they have excellent communication and analytical skills.

ScoreClaims AdjudicatorUS Average

Salary

3.5

Avg. Salary $44,556

Avg. Salary $59,228

Stability level

9.3

Growth rate -6%

Growth rate 0.3%

Diversity

4.7

Race

American Indian and Alaska Native 0.50%

Asian 6.12%

Black or African American 10.51%

Hispanic or Latino 15.34%

Unknown 4.51%

White 63.02%

Gender

female 76.94%

male 23.06%

Age - 43

Race

American Indian and Alaska Native 3.00%

Asian 7.00%

Black or African American 14.00%

Hispanic or Latino 19.00%

White 57.00%

Gender

female 47.00%

male 53.00%

Age - 43

Stress level

9.3

Stress level is very high

7.1 - high

Complexity level

9.6

Complexity level is advanced

7 - challenging

Work life balance

3.7

Work life balance is poor

6.4 - fair

Key steps to become a claims adjudicator

Explore claims adjudicator education requirements

Most common claims adjudicator degrees

Bachelor's

57.3 %

Associate

17.9 %

High School Diploma

8.6 %

Start to develop specific claims adjudicator skills

Skills	Percentages
Medical Terminology	8.75%
CPT	8.05%
Disability Claims	7.40%
Adjudicate Claims	6.39%
Quality Standards	5.89%

Complete relevant claims adjudicator training and internships

Accountants spend an average of 1-2 years on post-employment, on-the-job training. New claims adjudicators learn the skills and techniques required for their job and employer during this time. The chart below shows how long it takes to gain competency as a claims adjudicator based on U.S. Bureau of Labor Statistics data and data from real claims adjudicator resumes.

Research claims adjudicator duties and responsibilities

Manage appeals and authorizations by examining information and performing necessary adjustments.
Handle claims processing utilizing knowledge of medical coding standards, including HCPCS, CPT, and ICD-9.
Calculate refunds or credit balances involving reprocessing for partial adjustments and correct the CPT and ICD-9 codes.
Maintain compliance with HIPAA guidelines and regulations

Prepare your claims adjudicator resume

When your background is strong enough, you can start writing your claims adjudicator resume.

You can use Zippia's AI resume builder to make the resume writing process easier while also making sure that you include key information that hiring managers expect to see on a claims adjudicator resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose from 10+ customizable claims adjudicator resume templates

Build a professional claims adjudicator resume in minutes. Browse through our resume examples to identify the best way to word your resume. Then choose from 10+ resume templates to create your claims adjudicator resume.

Apply for claims adjudicator jobs

Now it's time to start searching for a claims adjudicator job. Consider the tips below for a successful job search:

Browse job boards for relevant postings
Consult your professional network
Reach out to companies you're interested in working for directly
Watch out for job scams

How do claims adjudicators rate their job?

-/5

5 stars

4 stars

3 stars

2 stars

1 star

Claims adjudicator reviews

A zippia user wrote a review on Sep 2019

Pros

What I like most about this job is that I am not immortal. Eventually I will die and no longer have to do this job.

Cons

The position discourages autonomy, makes mastery impossible, and exchanges purpose for procedure. In short, you are taught to suspect everyone, protect corporate money, and prioritize numbers over human beings. Adjudicate comes from the root word "judge." However, exercising judgement requires instilling confidence in making decisions. Yet, such confidence in adjudicators is actively removed, when noticed by administrators. Innovation is punished, while unquestioning compliance is rewarded. This job is like hitting yourself over the head with a hammer. It just feels so good when you stop.

A zippia user wrote a review on May 2019