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

What is a medical claims examiner and how to become one

Updated January 8, 2025

4 min read

For thorough individuals with outstanding managerial ability or understanding of medical terminology, a career in medical claims examining might be a good option.

Health insurance providers typically appoint medical claims investigators to review all insurance claims and ensure accuracy of records, compliance with standard requirements, and prompt care.

Although there are no standard qualification standards for medical claims examiners, most employers prefer a high school diploma. Others seek a bachelor's degree, ideally in a medical or life sciences specialty. You may pursue certification by the International Claim Association (ICA), which administers two coursework levels and certifies examinees with some work experience.

Following this profession, you are likely to be rewarded with a decent salary. In general, medical Claims Examiners make an average salary of $34,615 per year or $17 per hour.

ScoreMedical Claims ExaminerUS Average

Salary

3.3

Avg. Salary $42,773

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 5.26%

Black or African American 10.50%

Hispanic or Latino 16.98%

Unknown 4.41%

White 62.36%

Gender

female 83.41%

male 16.59%

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 examiner

Explore medical claims examiner education requirements

Most common medical claims examiner degrees

Bachelor's

36.1 %

Associate

26.6 %

High School Diploma

16.5 %

Start to develop specific medical claims examiner skills

Skills	Percentages
Medical Terminology	9.91%
Customer Service	9.37%
Data Entry	6.84%
Medical Treatment	4.83%
Computer System	4.53%

Complete relevant medical claims examiner training and internships

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

Gain additional medical claims examiner certifications

Medical claims examiner 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 examiner certification, having one may help you stand out relative to other applicants.

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

More About Certifications

Research medical claims examiner duties and responsibilities

Manage cases by aggressively directing the litigation process.
Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
Identify which claims are eligible for PPO reprising.

Prepare your medical claims examiner resume

When your background is strong enough, you can start writing your medical claims examiner 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 examiner 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 examiner resume templates

Build a professional medical claims examiner 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 examiner resume.