Health Claims Examiner: Salary & Job Market

When you receive a bill from your doctor, you find out how much your insurance company paid and how much must come out of your pocket to make up the difference. Large or small, the amounts are anything but arbitrary -- they were determined by a health claims examiner.

Duties of a health claims examiner
Health claims examiners review health-related claims in order to determine their validity and negotiate a settlement. These professionals interview medical specialists, check claim applications for accuracy, and consult policy files to verify the information reported in a claim. Based on guides that report average periods of disability, expected treatments, and average hospital stays, health claims examiners determine whether costs are reasonable and how much clients should be reimbursed.

At that point, health claims examiners either authorize payment to the client or refer the claim to an insurance investigator for further review.

Where to find health claims examiner jobs
Health claims examiner jobs are found primarily with health insurance carriers. Opportunities are also available within health insurance agencies and brokerages, federal government, state government, and management of companies and enterprises.

Health claims examiners usually specialize in individual or group insurance plans and in dental, hospital, or prescription drug claims.

Health claims examiner programs
A bachelor's degree can be an asset when looking for work as a health claims examiner. Courses in business, economics, law, and math are especially useful, as are courses in medical billing, records, and terminology. Continuing education is a must because of new federal and state laws and court decisions that affect how claims are handled and who insurance policies cover. Health claims examiners must also stay up to date on the latest medical procedures and prescription drugs.

Licensing requirements for health claims examiners vary by state, but some states require college coursework and a passing score on a licensing exam. Determine your state's requirements before embarking on any health claims examiner programs.

Demand for health claims examiner jobs
Health claims examiner jobs are in demand as a result of more insurance policies being sold to accommodate the growing U.S. population. In addition, the aging boomer population presents a greater need for health care, which translates into more work for health claims examiners. According to the Bureau of Labor Statistics, median annual earnings for health claims examiners in May 2007 were $53,560.

Help people make sense of their health insurance -- learn more about becoming a health claims examiner.

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