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

What is a medical claims analyst and how to become one

Updated January 8, 2025

4 min read

Quoted expert

Jill Bisco Ph.D., CIC, CRM, CPRM, CSRM

Medical claims analysts work very closely with insurance companies, investigating medical claims. They must be knowledgeable in the legal technicalities surrounding Medicare/Medicaid. Since they'll be handling sensitive documents on people's health, they must also comply with HIPAA guidelines and maintain the confidentiality of those records.

You don't need a college education to become a medical claims analyst. A high school diploma and GED is often enough to get you through the door. However, degrees in health care administration, business, nursing, and medical assisting services do make your resume more appealing to employers. Other qualifications include strong analytical, interpersonal, and critical thinking skills.

A medical claims analyst in the United States earns an average yearly salary of roughly about $49,000. However, top earners can make as much as $81,000 in the right company. Employers like AAA Southern New England and Stephens pay their medical claims analysts a competitive, above-average salary of $50,000 or more on average.

What general advice would you give to a medical claims analyst?

Jill Bisco Ph.D., CIC, CRM, CPRM, CSRM

Assistant Professor of Risk Management and Insurance, Website

I already mentioned - continue learning and, in the process, gain certifications or designations. Whether one continues their university education through a master's or doctorate, or gains designations such as the CPCU or CIC, the continuation of learning will show current and prospective employers a commitment and dedication to learn about the industry.

Be engaged! Get involved! Doing the bare minimum, or sometimes just doing your job, is no longer sufficient, although I'm not sure it ever was. Employees that get connected with organizations such as the Risk and Insurance Management Society (RIMS) or a Gamma Iota Sigma alumni chapter - stand out. Don't be afraid to engage in groups within or outside of your organization. Be different, be engaged, stand out!

ScoreMedical Claims AnalystUS Average

Salary

3.6

Avg. Salary $46,708

Avg. Salary $59,228

Stability level

9.3

Growth rate -6%

Growth rate 0.3%

Diversity

4.6

Race

American Indian and Alaska Native 0.50%

Asian 5.11%

Black or African American 11.22%

Hispanic or Latino 16.38%

Unknown 4.39%

White 62.40%

Gender

female 85.78%

male 14.22%

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 medical claims analyst

Explore medical claims analyst education requirements

Most common medical claims analyst degrees

Bachelor's

35.9 %

Associate

25.7 %

High School Diploma

13.2 %

Start to develop specific medical claims analyst skills

Skills	Percentages
Medical Terminology	9.47%
Medicaid	6.32%
Medical Insurance Claims	6.29%
Customer Service	6.27%
Data Entry	5.67%

Complete relevant medical claims analyst training and internships

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

Gain additional medical claims analyst certifications

Medical claims analyst certifications can show employers you have a baseline of knowledge expected for the position. Certifications can also make you a more competitive candidate. Even if employers don't require a specific medical claims analyst certification, having one may help you stand out relative to other applicants.

The most common certifications for medical claims analysts include Certified Billing and Coding Specialist (CBCS) and Medical Assistant.

More About Certifications

Research medical claims analyst duties and responsibilities

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.

Prepare your medical claims analyst resume

When your background is strong enough, you can start writing your medical claims analyst 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 medical claims analyst resume. You'll find resume tips and examples of skills, responsibilities, and summaries, all provided by Zippi, your career sidekick.

Choose from 10+ customizable medical claims analyst resume templates

Build a professional medical claims analyst 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 medical claims analyst resume.