How do I Become a Medical Claims Analyst?

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  • Written By: Carol Francois
  • Edited By: A. Joseph
  • Last Modified Date: 09 October 2018
  • Copyright Protected:
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A medical claims analyst works in the health insurance or services industry. He or she is responsible for reviewing all medical claims over a specific period of time and identifying patterns and trends. The things you would need to become a medical claims analyst include critical thinking skills, computer skills and formal training in this field.

The most important skill for anyone who wants to become a medical claims analyst is the ability to recognize patterns. The analyst is expected to work with a variety of tools to review huge sets of data. The ability to formulate a theory on behavior and trends and create the query to look for this pattern is very important. Although the techniques used are covered in the formal training, practice is required to obtain a professional level of skill.

Critical thinking is a combination of several problem-solving techniques used to assist in the decision-making process. Data is collected from reliable sources, and a series of iterative questions are posed to arrive at a list of options. This method of solving problems relies heavily on data and logic, and it tends to disregard emotions or intuition. These techniques are very useful if you want to become a medical claims analyst.


Intermediate or advanced computer skills are essential if you want to become a medical claims analyst. The vast majority of the day is spent using computer programs to select data, run reports and queries and review the results. These skills can be learned through formal education or employer-provided training.

There is no specific degree or diploma in claims analysis. However, a college degree in business administration or statistics is quite relevant and provides the skills necessary to perform this job successfully. In many cases, a health insurance company or government agency is looking for job candidates who have completed post-secondary education. Additional training is provided in the actual programs and methods used by the organization.

Career advancement opportunities for a medical claims analyst include working as a department supervisor, manager or senior analyst. In order to be considered for these positions, talk with the human resources professionals about the academic credentials and experience required to move forward. On occasion, additional courses in management, supervision or computer software is recommended. Think about soft skills, such as communication and conflict resolution, that are important in a management position. Working with a career counselor is a great way to identify your strengths and formulate a plan to move to the next stage of your career.



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