Career Profile: Medical Claims Examiner

Nurse Anesthesiologist

Job Description:

The main role of a medical claims examiner is to investigate and verify the medical claims filed by the insurance holders. Medical claims examiner professionals are primarily tasked to protect insurance companies against monetary losses due to false and unreasonable claims. However, they should be careful as not to violate the rights of the insurance holders since they are protected by the Federal Government. Technically, they are hired by insurance companies to determine if the claims submitted are valid or not. Medical claims examiner professionals shield insurance companies from fraudulent activities while at the same time looking out for the best interest of the insurance holders.

As a medical claims examiner, you are expected to take on the following duties and responsibilities:

  • carefully assess health-related claims
  • check claims for accuracy and legitimacy
  • conduct interviews to medical specialists and other healthcare professionals to establish the validity of medical claims
  • endorse appropriate payments for verified claims
  • collaborate with special investigators to investigate suspected fraud claims

Overall, medical claims examiner professionals have to closely examine each and every claim filed by the insurance holder to ascertain its validity in order to provide the claimant with the appropriate amount of reimbursements.

  • echocardiography
  • vascular technology
  • neurosonology
  • obstetrics and gynecology
  • ophthalmology
Work Environment:

Most medical claims examiner professionals are employed by life and health insurance companies. They work 5-days a week, and 8 hours a day in a typical office setting. They can also make special arrangement for their work schedule in order to accommodate evening and weekend appointments to clients.

Education and Training Requirements:

Although there is no standard educational requirement for aspiring medical claims examiner professionals, it is still highly recommended that they get formal education from accredited medical claims examiner schools.

Medical claims examiner courses are being offered in vocational schools, community colleges, and some universities. Online medical claims examiner training programs are also ideal for those who have time constraints.

It is advised that medical claims examiner aspirants pursue continuing studies program since the laws on insurance claims are always changing, thus, greatly affecting the way claims are being handled.

Salary Range:

The earnings of most medical claims examiners fall within the $42,400 - $70,689 income bracket. Their salary rate is typically affected by certain factors, including work experience, educational background, special skills, and expertise. Those who have acquired higher educational degrees will definitely receive lucrative compensation rates as compared to those who did not get any formal training.

Job Outlook:

The overall employment outlook for medical claims examiner professionals is very promising. In fact, the demand for medical claims examiners is anticipated to increase by 7% in the next 10 years. Job openings for medical claims examiners will spawn from the growth of the health insurance industry. Moreover, their expertise will be greatly needed to scrupulously examine the increasing number of medical claims.

Jumpstart a rewarding medical claims examiner career by browsing through our extensive list of medical claims examiner schools so you can start your training today

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