0 selections
0 selections

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.

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.

Learn more about what a Medical Claims Specialist does

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

Average Salary for a Medical Claims Specialist

Medical Claims Specialists in America make an average salary of $37,008 per year or $18 per hour. The top 10 percent makes over $43,000 per year, while the bottom 10 percent under $31,000 per year.
Average Medical Claims Specialist Salary
$37,008 Yearly
$17.79 hourly
$31,000
10 %
$37,000
Median
$43,000
90 %

What Am I Worth?

0 selections
0 selections
salary-calculator

Medical Claims Specialist Education

Medical Claims Specialist Majors

22.0 %
7.5 %

Medical Claims Specialist Degrees

Bachelors

38.5 %

Associate

28.4 %

High School Diploma

12.5 %

Top Colleges for Medical Claims Specialists

1. University of Pennsylvania

Philadelphia, PA • Private

In-State Tuition
$55,584
Enrollment
10,764

2. California State University - Bakersfield

Bakersfield, CA • Private

In-State Tuition
$7,309
Enrollment
9,142

3. University of Southern California

Los Angeles, CA • Private

In-State Tuition
$56,225
Enrollment
19,548

4. Stanford University

Stanford, CA • Private

In-State Tuition
$51,354
Enrollment
7,083

5. SUNY Stony Brook

Stony Brook, NY • Private

In-State Tuition
$9,625
Enrollment
17,407

6. New York University

New York, NY • Private

In-State Tuition
$51,828
Enrollment
26,339

7. Maria College of Albany

Albany, NY • Private

In-State Tuition
$15,140
Enrollment
876

8. University of Minnesota - Twin Cities

Minneapolis, MN • Private

In-State Tuition
$14,760
Enrollment
31,451

9. Duke University

Durham, NC • Private

In-State Tuition
$55,695
Enrollment
6,596

10. Howard University

Washington, DC • Private

In-State Tuition
$26,756
Enrollment
6,166

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 Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume
Medical Claims Specialist Resume

Medical Claims Specialist Demographics

Medical Claims Specialist Gender Distribution

Female
Female
83%
Male
Male
17%

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%.

Online Courses For Medical Claims Specialist That You May Like

Advertising Disclosure  The courses listed below are affiliate links. This means if you click on the link and purchase the course, we may receive a commission.
Medical Coding: ICD-10-CM Essentials
udemy
4.4
(397)

Easy, effective, and engaging education on ICD-10-CM Medical Diagnosis Coding...

Medical Coding: ICD-10-CM Diagnosis Code Training
udemy
4
(560)

Learn medical coding and prepare yourself for today's healthcare workplace...

Medical Terminology
udemy
4.6
(1,169)

Introduction to the meaning of various roots, terms and combining forms that are components of medical words...

Show More Medical Claims Specialist Courses
Job type you want
Full Time
Part Time
Internship
Temporary

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

Total Medical Claims Specialist Jobs:
705
Highest 10% Earn:
$47,000
Location Quotient:
2.11 Location Quotient is a measure used by the Bureau of Labor Statistics (BLS) to determine how concentrated a certain industry is in a single state compared to the nation as a whole. You can read more about how BLS calculates location quotients here

2. Minnesota

Total Medical Claims Specialist Jobs:
1,278
Highest 10% Earn:
$46,000
Location Quotient:
1.74 Location Quotient is a measure used by the Bureau of Labor Statistics (BLS) to determine how concentrated a certain industry is in a single state compared to the nation as a whole. You can read more about how BLS calculates location quotients here

3. Oregon

Total Medical Claims Specialist Jobs:
375
Highest 10% Earn:
$56,000
Location Quotient:
0.82 Location Quotient is a measure used by the Bureau of Labor Statistics (BLS) to determine how concentrated a certain industry is in a single state compared to the nation as a whole. You can read more about how BLS calculates location quotients here
Full List Of Best States For Medical Claims Specialists

How Do Medical Claims Specialist Rate Their Jobs?

Working as a Medical Claims Specialist? Share your experience anonymously.
Do you work as a Medical Claims Specialist?
Rate how you like work as Medical Claims Specialist. It's anonymous and will only take a minute.

Top Medical Claims Specialist Employers

Most Common Employers For Medical Claims Specialist

Rank  Company  Average Salary  Hourly Rate  Job Openings  
1Delaware State Government$43,848$21.088
2Blue Cross Blue Shield of North Carolina$42,509$20.4415
3AIG$39,163$18.839
4Progressive$38,752$18.636
5Allstate$38,471$18.5012
6Revecore$38,291$18.417
7Anthem$38,204$18.377
8Nationwide$38,102$18.3259
9HealthNet$37,905$18.226
10Highmark$37,743$18.156

Medical Claims Specialist Videos