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

What is a claims benefit specialist and how to become one

Updated January 8, 2025

4 min read

How do insurance companies decide to honor a claim, and which kind of coverage is available to a client? This is usually the job of the claims benefit specialist. They examine people's claims for coverage and decide if they deserve compensation or not.

The claims benefit specialist needs to have a good head for details. They have to know the detailed ins and outs of a company's benefit plan so they know which claims are eligible. They also need to spot which details don't add up in order to investigate any false claims. The claims benefit specialist also needs to process any payments accurately in order to prevent angry customers.

Most of the skills needed to become a claims benefit specialist can be developed on the job. In fact, only a few claims benefit specialists have bachelor's degrees. Practical experience in customer service or as a claims processor is valued by employers more than a diploma.

ScoreClaims Benefit SpecialistUS Average

Salary

3.7

Avg. Salary $47,292

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 5.24%

Black or African American 11.37%

Hispanic or Latino 16.89%

Unknown 4.40%

White 61.60%

Gender

female 80.37%

male 19.63%

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 benefit specialist

Explore claims benefit specialist education requirements

Most common claims benefit specialist degrees

Bachelor's

40.1 %

Associate

27.4 %

High School Diploma

16.8 %

Start to develop specific claims benefit specialist skills

Skills	Percentages
Customer Inquiries	10.52%
Appeals	6.99%
Medical Terminology	5.69%
Routine Claims	5.23%
CPT	4.32%

Complete relevant claims benefit specialist training and internships

Accountants spend an average of 1-2 years on post-employment, on-the-job training. New claims benefit specialists 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 benefit specialist based on U.S. Bureau of Labor Statistics data and data from real claims benefit specialist resumes.

Research claims benefit specialist duties and responsibilities

Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
Analyze each claim and calculate percentages for both PPO and NON-PPO providers.

Prepare your claims benefit specialist resume

When your background is strong enough, you can start writing your claims benefit specialist 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 benefit specialist 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 benefit specialist resume templates

Build a professional claims benefit specialist 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 benefit specialist resume.