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

What is a medical claims specialist and how to become one

Updated January 8, 2025

4 min read

Medical claims specialists are medical professionals who are responsible for obtaining and processing medical insurance claim information for healthcare providers and patients. Their duties include, but are not limited to, determining which medical claims are covered under various health insurance policies, documenting, denying, or accepting these claims, respond to customer inquiries, providing legal support if needed by assembling documentation for possible insurance settlements, and adjusting insurance claims.

Medical claims specialists work directly with insured clients by helping them understand their insurance coverage, to examine and resolve medical claims, documenting claims, and ensuring that all claims are processed within company and legal guidelines. As such, it is essential for medical claims specialists to have excellent customer service skills, as well as above-average written and verbal communication skills.

There is no advanced degree requirement for obtaining a job as a medical claims specialist. The majority of medical claims specialists make up to $35,000 a year, with job growth in the U.S. expected to grow by 11% by 2028.

ScoreMedical Claims SpecialistUS Average

Salary

2.8

Avg. Salary $35,706

Avg. Salary $59,228

Stability level

4.8

Growth rate 11%

Growth rate 0.3%

Diversity

6.3

Race

American Indian and Alaska Native 1.25%

Asian 8.27%

Black or African American 9.52%

Hispanic or Latino 16.96%

Unknown 4.19%

White 59.81%

Gender

female 83.27%

male 16.73%

Age - 46

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 - 46

Stress level

4.8

Stress level is manageable

7.1 - high

Complexity level

6.0

Complexity level is intermediate

7 - challenging

Work life balance

8.6

Work life balance is excellent

6.4 - fair

Key steps to become a medical claims specialist

Explore medical claims specialist education requirements

Most common medical claims specialist degrees

Bachelor's

38.5 %

Associate

28.4 %

High School Diploma

12.5 %

Start to develop specific medical claims specialist skills

Skills	Percentages
Customer Service	14.01%
Patients	8.59%
Medicaid	6.67%
Medical Billing	6.29%
Phone Calls	5.67%

Complete relevant medical claims specialist training and internships

Accountants spend an average of Less than 1 month on post-employment, on-the-job training. New medical claims 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 medical claims specialist based on U.S. Bureau of Labor Statistics data and data from real medical claims specialist resumes.

Gain additional medical claims specialist certifications

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

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

More About Certifications

Research medical claims specialist duties and responsibilities

Apply Medicare, Medicaid billing guidelines to achieve maximum reimbursement.
Detail knowledge of medical coding; ICD-9, CPT and HCPCS codes.
Confirm coverage and work with private payers, commercial payers, Medicaid, and Medicare for reimbursement of provide medical services.
Research medical records, compliance requirements and explanations of benefits to resolve accounts payable for Medicare, Medicaid and commercial insurance.

Prepare your medical claims specialist resume

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

Build a professional medical claims 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 medical claims specialist resume.