According to recent statistics, health care fraud amounts to nearly 20% of the total waste in U.S. health care spending per year. Health claims examiners are on the front lines, detecting potential fraud and investigating the validity of claims in an attempt to reduce this deficit. Providing an important service to health insurance companies and medical providers alike, claims examiners are in high demand.
What Does a Health Claims Examiner Do?
Generally employed by health insurance companies or medical facilities, a health claims examiner reviews claims for accuracy, completeness, and potential concerns. While not a requirement to enter the profession, earning a health claims examiner certification equips you with the tools needed to exceed expectations and advance. Coursework generally includes the following:
- Medical billing and coding
- Medical terminology and anatomy
- Health care law and policy
- Medical ethics
- Knowledge of medical specializations, such as psychology and cardiology
Ideal for individuals who enjoy research, problem solving, and paying close attention to detail, a career as a health claims examiner provides a stable professional and financial future. Generally completed in less than a year, certification as a health claims examiner gives you a competitive edge and potentially a higher entry-level salary.
Where Do Health Claims Examiners Work?
Typically, claims examiners are employed by insurance companies, medical facilities, or hospitals. Though less common, employment with a third party agency, such as a review board or auditing group, is an option. Regardless of the employer, examiners seek inconsistencies, identify errors, and evaluate the appropriateness of care as outlined by claims and medical records. The outcome of an examiner’s hard work is a streamlined claims process that prevents fraud and error while ensuring patient access to care. In a provider setting, claims examiners ensure accuracy of claim submissions to prevent rejections and review, correct, and resubmit returned claims.
Enjoy a Profession with Room to Grow
Earning your certification as a health claims examiner leads to a stable, lucrative career with room to grow. Many successful claim examiners find themselves drawn further into health care policy, risk management, or administration. If you have a passion for numbers, medicine, and research, consider becoming certified as a health claims examiner.