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How Do I Become a Medical Claims Examiner?

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  • Written By: Mary McMahon
  • Edited By: Nancy Fann-Im
  • Last Modified Date: 10 June 2019
  • Copyright Protected:
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    Conjecture Corporation
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A person who wants to become a medical claims examiner does not need any special training and can pursue several avenues to this career path. Claims examiners review insurance claims to determine whether the policy should pay out, based on the nature of the claim and standards and practices at the insurance company. This work does not require a college degree or certification from a vocational school, although these can be helpful in a tight job market.

One way to become a medical claims examiner is to start working in the insurance industry to build up experience. Regional agencies often hire support and administrative personnel, and some support their employees as they work up the career ladder. Employees can also apply directly to headquarters to work in an office environment with claims examiners and other corporate personnel. As an employee develops experience and learns about the company, it is possible to apply to become a medical claims examiner.

Another option is to go to college for a degree before applying into the insurance industry, which may potentially allow someone to skip some of the steps along the way to become a medical claims examiner. Students can get degrees in business and a variety of other fields, including topics like medicine and nursing that might help them understand insurance claims. Some people go to trade schools to learn medical billing and coding and apply this training to their work as claims examiners.

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An insurance company may prefer an applicant to become a medical claims examiner if the person has insurance industry experience, professional training, or administrative experience. Students who have just graduated from high school typically have trouble entering positions like this, although they may be able to apply to work as administrative assistants to start building up experience and skills. People with experience in the medical profession, like former clinic assistants, may also have an advantage on applications for work in the insurance industry.

After someone has become a medical claims examiner, it is important to keep up with policies and procedures at the insurance company. Policy changes should be closely reviewed to make sure they are fully understood. It can also help to monitor appeals and disputes, as these can help claims examiners determine how and why people appeal their decisions. This information may be helpful for formulating solid arguments to back up a denial, which will be useful when the denial is appealed and another staff member needs to review the documentation.

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