How to Become a Health Claims Specialist


A health claims specialist is a professional who is trained and knowledgeable in processing hospital bills, medical insurance claims and sorting out any issues that may arise in billing. Another term for a health claims specialist is a medical billing and coding specialist. The job of a health claims specialist revolves around fool-proof documentation, ensuring legal compliance and making sure that health providers get compensated for their services.

If you are good with paperwork, thorough with documentation, possess an appreciation for detail and desire to have an office based career in the expanding health care industry then becoming a health claims specialist may be the ideal career direction for you. Not only will you enjoy your work life but will also welcome expansion opportunities.

Job Duties

Health claims specialists can work in various organizational setups such as hospitals, clinics, medical billing agencies, government agencies, insurance companies, health maintenance organizations and so on. Therefore the job duties may vary depending on where one can find a job as standards and policies vary. However, the list below outlines the basic job duties that will be common to most health claims specialists.

  1. Maintain and archive patient records that compiles complete personal and hospital data
  2. Document all medical claims with supporting documents, reports, logs, transactions and forms
  3. Remain up to date with hospital policies as well as insurance company policies
  4. Calculating payments, dues, losses or additional costs through studying medical paperwork and expenses
  5. Provide insurance advice and information to customers to maintain customer quality
  6. Prepare systematic reports on claims for hospitals and insurance companies by compiling, sorting and analyzing relevant information
  7. Electronically record information that can easily be stored, archived, retrieved and outputted.
  8. Give priority on protecting customer confidentiality and data security
  9. Investigate pending claims and follow up on loose ends so that all discrepancies are solved
  10. Process routine medical insurance claims by ensuring full, accurate and complete availability of all relevant information.

Career Outlook

The career outlook for health claims specialists is quite favorable especially in countries where there is a strong presence and usage of medical insurance. According to the Bureau of Labor Statistics Occupational Outlook Handbook (, it is expected that there will be a growth of 21 percent in the employment of medical records and health information technicians. This growth is expected during the period of 2010 and 2020 and translates to roughly 37,700 new jobs.

Due to the increase in medical insurance options for the public and an aging population, the demand for health claims specialists is on the rise. Another contributing factor is the increased awareness of preventative medicine as people have realized it is important to plan ahead and take precautionary measures when it comes to their health. All these factors have increased the need for medical tests, treatments, procedures and paperwork which in turn have increased the demand for medical claims specialists.

Salary Prospects

The average annual salary for a health claims specialists is $50,000 ( According to another source, the median yearly salary for health claims specialists is $47,000 ( The chances of earning a higher salary increase as you gain more experience in the market. This is because employers may give preference to those applicants who have previous experience with handling claims and are already familiar with the system.

What Education Do You Need to Become a Health Claims Specialist

One can gain an entry level or assistant level job in the health claims field with just a high school diploma and could work their way up from there. However, employers may give preference to those candidates who have some academic exposure to health information technology or medical billing. A degree in health information technology should help you develop a strong foundation – after which the next step for a career boost would be to get certified. To attain certification is a great way to rise up the ranks.

Since there are no direct degree programs offered to become a health claims specialist, you will find a number of certificates or vocational programs that may help you. You can complete the certified professional coder exam ( which is offered by American Academy of Professional Coders (

For more certification needs you should refer to the American Health Information Management Association. The Electronic Health Record Specialist Certification is offered through the National Healthcareer Association is also a great credential to gain that should assist you in becoming a health claims specialist.  These certificate programs will increase your marketability and improve your market value. It is advised that you check with state policies and employers to find out which certification is given preference. With a certification under your belt, employers will recognize that you possess the necessary skills and expertise for the job as a minimum standard of excellence is guaranteed.

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