Medical Claims Examiners Career

Overview and Job Duties

Sometimes a person wants nothing more than the sense of fulfillment that comes with doing a challenging job. Not everyone has the stamina or passion to become a medical claim examiner, due to the tremendous amount of patience the job requires. This is what sets some apart from the rest, and what makes some people well-suited to a career in this fast-paced and exciting field. Being a medical claim adjuster can be tiring, but it’s frequently rewarding, particularly if you’ve mastered the art of convincing others to take your point of view. Read on to discover more about this unique career path.

Before deciding to become a medical claims examiner, it is important to know about the industry. Claims examiners’ primary duty is to verify insurance claims. Usually, health insurance firms hire these specialists to help protect the business from any fraudulent claims that might result from unethical customers they insure. Most of the work revolves around paperwork. If the examiner has any doubts about the authenticity of a claim or finds any reason to suspect fraud, he or she organizes interviews with the medical specialists involved to clear up any confusion. Examiners also closely monitor policy changes to ensure that customers completely understand them. They might even observe disputes and appeals resulting from their findings. Examiners also frequently help in the formulation of case agreements.

Job Outlook

One sure way to start on the path to becoming a medical claims examiner is to acquire relevant, on-site experience by working within the insurance industry. As a regular employee, would-be examiners develop field-related skills and learn about multiple issues concerning corporations and insurance-related fraud. After gaining some experience, employees might apply for a claims examiner position in regional or national headquarters, or as part of a different company entirely. An insurance company could hire an applicant to become a medical claims examiner only if the person has administrative, insurance business, or training expertise. Medical claim adjusters may also work in areas affected by natural disasters, as well as many others positions in the healthcare sector.


In 2011, the US Bureau of Labor Statistics found the median annual salary for medical claims adjusters to be $59,320. As with any job, this figure depends largely on employer, employee experience, and location.

Educational Requirements

There are no mandatory educational criteria or training courses for becoming a medical claim adjuster. Despite that, some employers look for candidates with a bachelor’s degree or a high school diploma in either life sciences or medicine. The candidates might also have the option to pursue careers as insurance appraisers and auto damage appraisers. Medical examiners may get certified through International Claim Association (ICA).

On the other hand, candidates might even apply for an online medical billing and coding degree or certification, in case they are unable to get enrolled in a campus-based institution. Whatever path the candidate chooses, he or she should be aware that while there is no required educational minimums, specialized education and training will go a long way toward getting him or her the desired position in a competitive job market.

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