Medical Insurance Claims Processor Info

Most medical claims are submitted to the insurance company automatically, via computer. The computer is programmed to identify specific codes and approve or deny a claim based on this information. However, there are times when a claim needs more analysis, and does not have a clear-cut answer that the computer can read. This is when a Medical Insurance Claims Processor is necessary. A Medical Insurance Claims Processor enters your data into a computer database to determine what type of coverage you have, answers customer questions about his or her policy and coverage, and delves into your medical history to determine whether your claim should be approved or denied.

Skills
A Medical Insurance Claims Processor must be detailed oriented, so that he or she can identify that all of the information in a claim is accurate, and compare it to the insurance plan to determine coverage. Because deadlines are often tight, Medical Insurance Claims Processors must be able to multi-task and prioritize so they can process claims quickly and efficiently. Medical Insurance Claims Processors should have good communication skills so they can speak with the patient and the insurance company effectively. Basic computer knowledge is a must, so they can navigate through the system efficiently.

Education & Training
To become a Medical Insurance Claims Processor, you must have a high school diploma. Most employers also require prior experience in a medical office, or equivalent educational experience, such as a medical billing and coding degree. Basic computer training is also necessary if you don’t have prior experience working with computers.

Outlook
The job outlook for Medical Insurance Claims Processors, and the healthcare field in general, is very positive. It is growing rapidly, with the Bureau of Labor Statistics predicting a growth of 22% by the year 2018.

Learn more about Medical Billing and related careers.