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.
There is more than meets the eye when it comes to being a claims adjudicator. For example, did you know that they make an average of $19.1 an hour? That's $39,738 a year!
Between 2018 and 2028, the career is expected to grow -4% and produce -13,000 job opportunities across the U.S.
There are certain skills that many claims adjudicators have in order to accomplish their responsibilities. By taking a look through resumes, we were able to narrow down the most common skills for a person in this position. We discovered that a lot of resumes listed communication skills, math skills and analytical skills.
When it comes to the most important skills required to be a claims adjudicator, we found that a lot of resumes listed 14.2% of claims adjudicators included medical records, while 7.8% of resumes included cpt, and 6.9% of resumes included disability claims. Hard skills like these are helpful to have when it comes to performing essential job responsibilities.
When it comes to searching for a job, many search for a key term or phrase. Instead, it might be more helpful to search by industry, as you might be missing jobs that you never thought about in industries that you didn't even think offered positions related to the claims adjudicator job title. But what industry to start with? Most claims adjudicators actually find jobs in the health care and insurance industries.
If you're interested in becoming a claims adjudicator, one of the first things to consider is how much education you need. We've determined that 50.3% of claims adjudicators have a bachelor's degree. In terms of higher education levels, we found that 6.1% of claims adjudicators have master's degrees. Even though most claims adjudicators have a college degree, it's possible to become one with only a high school degree or GED.
Choosing the right major is always an important step when researching how to become a claims adjudicator. When we researched the most common majors for a claims adjudicator, we found that they most commonly earn bachelor's degree degrees or associate degree degrees. Other degrees that we often see on claims adjudicator resumes include high school diploma degrees or master's degree degrees.
You may find that experience in other jobs will help you become a claims adjudicator. In fact, many claims adjudicator jobs require experience in a role such as customer service representative. Meanwhile, many claims adjudicators also have previous career experience in roles such as claim processor or sales associate.