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.
How to Become a Medical Claims Specialist
There is more than meets the eye when it comes to being a medical claims specialist. For example, did you know that they make an average of $17.79 an hour? That's $37,008 a year!
Between 2018 and 2028, the career is expected to grow 11% and produce 23,100 job opportunities across the U.S.
What Does a Medical Claims Specialist Do
There are certain skills that many medical claims specialists 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 integrity, technical skills and analytical skills.
How To Become a Medical Claims Specialist
If you're interested in becoming a medical claims specialist, one of the first things to consider is how much education you need. We've determined that 38.5% of medical claims specialists have a bachelor's degree. In terms of higher education levels, we found that 4.0% of medical claims specialists have master's degrees. Even though some medical claims specialists 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 medical claims specialist. When we researched the most common majors for a medical claims specialist, we found that they most commonly earn bachelor's degree degrees or associate degree degrees. Other degrees that we often see on medical claims specialist resumes include high school diploma degrees or diploma degrees.
You may find that experience in other jobs will help you become a medical claims specialist. In fact, many medical claims specialist jobs require experience in a role such as customer service representative. Meanwhile, many medical claims specialists also have previous career experience in roles such as administrative assistant or cashier.
Medical Claims Specialist Career Paths
In addition to switching up your job search, it might prove helpful to look at a career path for your specific job. Now, what's a career path you ask? Well, it's practically a map that shows how you might advance from one job title to another. Our career paths are especially detailed with salary changes. So, for example, if you started out with the role of billing specialist you might progress to a role such as team leader eventually. Later on in your career, you could end up with the title practice manager.
Average Salary for a Medical Claims Specialist
What Am I Worth?
Top Colleges for Medical Claims Specialists
1. University of Pennsylvania
Philadelphia, PA • Private
2. California State University - Bakersfield
Bakersfield, CA • Private
3. University of Southern California
Los Angeles, CA • Private
4. Stanford University
Stanford, CA • Private
5. SUNY Stony Brook
Stony Brook, NY • Private
6. New York University
New York, NY • Private
7. Maria College of Albany
Albany, NY • Private
8. University of Minnesota - Twin Cities
Minneapolis, MN • Private
9. Duke University
Durham, NC • Private
10. Howard University
Washington, DC • Private
Top Skills For a Medical Claims Specialist
The skills section on your resume can be almost as important as the experience section, so you want it to be an accurate portrayal of what you can do. Luckily, we've found all of the skills you'll need so even if you don't have these skills yet, you know what you need to work on. Out of all the resumes we looked through, 22.2% of medical claims specialists listed medical records on their resume, but soft skills such as integrity and technical skills are important as well.
Choose From 10+ Customizable Medical Claims Specialist Resume templates
Zippia allows you to choose from different easy-to-use Medical Claims Specialist templates, and provides you with expert advice. Using the templates, you can rest assured that the structure and format of your Medical Claims Specialist resume is top notch. Choose a template with the colors, fonts & text sizes that are appropriate for your industry.
Medical Claims Specialist Demographics
Medical Claims Specialist Gender Distribution
After extensive research and analysis, Zippia's data science team found that:
- Among medical claims specialists, 83.3% of them are women, while 16.7% are men.
- The most common race/ethnicity among medical claims specialists is White, which makes up 66.1% of all medical claims specialists.
- The most common foreign language among medical claims specialists is Spanish at 55.6%.
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Best States For a Medical Claims Specialist
Some places are better than others when it comes to starting a career as a medical claims specialist. The best states for people in this position are Oregon, Washington, Wyoming, and Minnesota. Medical claims specialists make the most in Oregon with an average salary of $46,021. Whereas in Washington and Wyoming, they would average $44,416 and $42,162, respectively. While medical claims specialists would only make an average of $41,418 in Minnesota, you would still make more there than in the rest of the country. We determined these as the best states based on job availability and pay. By finding the median salary, cost of living, and using the Bureau of Labor Statistics' Location Quotient, we narrowed down our list of states to these four.
1. Kansas
$40,453
Avg. Salary
2. Minnesota
$41,418
Avg. Salary
3. Oregon
$46,021
Avg. Salary
How Do Medical Claims Specialist Rate Their Jobs?
Top Medical Claims Specialist Employers
Most Common Employers For Medical Claims Specialist
| Rank  | Company  | Average Salary  | Hourly Rate  | Job Openings  |
|---|---|---|---|---|
| 1 | Delaware State Government | $43,848 | $21.08 | 8 |
| 2 | Blue Cross Blue Shield of North Carolina | $42,509 | $20.44 | 15 |
| 3 | AIG | $39,163 | $18.83 | 9 |
| 4 | Progressive | $38,752 | $18.63 | 6 |
| 5 | Allstate | $38,471 | $18.50 | 12 |
| 6 | Revecore | $38,291 | $18.41 | 7 |
| 7 | Anthem | $38,204 | $18.37 | 7 |
| 8 | Nationwide | $38,102 | $18.32 | 59 |
| 9 | HealthNet | $37,905 | $18.22 | 6 |
| 10 | Highmark | $37,743 | $18.15 | 6 |
Medical Claims Specialist Videos
