Pros and Cons of a Health Claims Specialist Career
The demand for healthcare services in the next decade will provide opportunities for trained professionals in the health information field. Evaluate the pros and cons of a health claims specialist career to decide if it is right for you.
| Pros of a Health Claims Specialist Career |
|---|
| High projected employment growth (15% expected growth between 2014 and 2024)* |
| Can enter the field with a certificate or associate's degree* |
| Comfortable work environment* |
| Positions available in a variety of settings including physician's offices, hospitals, insurance companies and government agencies* |
| Cons of a Health Claims Specialist Career |
|---|
| Employers may require professional certification* |
| High stress level due to consequences of errors** |
| Professional certification and changes in the field may require continuing education* |
| May require the ability to remain composed when communicating with health insurance policyholders** |
Sources: *U.S. Bureau of Labor Statistics, **O*NET OnLine.
Career Information
Job Description and Duties
In a medical institution, such as a physician's office or hospital, health claims specialists process patient claims for payments by insurance companies or government agencies. As a claims specialist, you will audit claims for completeness and accuracy and you may meet with medical professionals to clarify a diagnosis or verify the information in the patient's record. Health claim specialists may work directly for a medical facility or a medical billing company, which provides billing services for physician's offices and hospitals.
You may also work for insurance companies, verifying the accuracy and completeness of claims and authorizing payment. When working as a specialist for an insurance company, you will determine if the patient's insurance policy covers the medical procedure or treatment before authorizing payment.
Career Prospects and Salary Info
According to the U.S. Bureau of Labor Statistics (BLS), employment for medical records and health information technicians is expected to increase by 15% between 2014 and 2024 (www.bls.gov). The BLS attributed the growth in the field to the aging population and the increased demand for health services. The BLS also said that those who obtain a professional credential in the field will have the best employment prospects. The BLS also reported that the annual median salary for a medical records and health information technician was around $35,000 as of 2014.
What Are the Requirements?
Employers require health information technicians complete a certificate or degree program to work as a claims specialist. In a health information program, you will complete coursework in anatomy and physiology, medical terminology, coding systems, reimbursement methods and heath information requirements. Your medical billing or health information program will also cover insurance and hospital billing methods.
If you have a high school education and experience in medical insurance claims or the medical billing and coding field, you can also qualify for positions with some employers. Professional certification through an organization, such as the American Health Information Management Association, may also be a requirement for employment and demonstrates your knowledge in the field.
Job Postings from Real Employers
Employment opportunities for health claims specialists exist in doctor's offices, insurance companies and hospitals. Employers look for job candidates with a combination of experience handling insurance claims and medical billing and education. Some positions require a degree in business administration in addition to experience in the field. Below are examples of health claim specialist job listings available in April 2012:
- A Florida employer in the insurance industry is seeking a claims specialist to audit physician and healthcare facility contracts and claims for payment. The specialist will work with healthcare providers to communicate updates on their claims for payment. The candidate must have a minimum of an associate's degree in health or business administration and at least five years of experience with insurance claims. A minimum of one year of experience with healthcare claims is needed to qualify for the position.
- A North Carolina employer in the health services industry is looking for a claims specialist to process claims to insurance companies for payment. The specialist must also monitor the claims process and denials to maintain the quality of the payment processing system. Candidates for the position must have a minimum of a high school education and four years of experience in the healthcare claims industry. Those with a four-year degree in business administration may qualify for the position without experience in the field. Job candidates with an associate's degree in business administration or accounting can qualify for the position with one year of experience in claims.
- An employer in Colorado in the insurance industry is seeking a medical claims specialist to evaluate claims for payment. The specialist will make payment decisions based on the policyholder's coverage and state mandates. The job candidate must have an undergraduate degree or an equivalent amount of experience in insurance claims or customer service. In addition, the employer requires the claims specialist complete a claims certification program.
How to Stand Out in the Field
Develop Related Skills
As a health claims specialist, you will interact with physicians, policyholders and medical billing employees in physician's offices. This requires skills in customer service and a positive attitude. You should include any customer service experience on your resume to highlight your interpersonal skills to potential employers. A cheerful and pleasant demeanor during interviews can also emphasize your customer service skills.
Developing office skills, such as word processing and spreadsheets, can also help you stand out in the crowd. You should also try to improve your typing speed and accuracy to stand out as the ideal candidate to perform the data entry duties of the job. To do this, you can take typing classes, many of which you can find online. You should also accentuate your written and verbal communication skills on your resume. The BLS also mentioned that you can stand out by taking classes in health, computer science, math and biology while you're in high school.
Other Careers to Consider
If a career in health information technology is appealing, but the salary of a health claims specialist is a deterrent, a position as a health information manager may be a better choice. Health information managers oversee the maintenance of patient records and ensure the information is secure. You will need a minimum of a bachelor's degree in health administration for an entry-level position and some employers require a master's degree. According to the BLS, the median annual salary for a medical and health services manager was about $86,000 in 2011.
If you have experience in insurance claims, there are additional opportunities in the health insurance industry. Health insurance underwriters work in the insurance industry to determine an applicant's eligibility, coverage and premium amounts. According to the BLS, insurance companies prefer candidates with a bachelor's degree education, but experience in the field may be sufficient to qualify for a position. The BLS also reported that the annual median salary for insurance underwriters in 2011 was around $61,000.
