What does a Claims Processor do?
Published 4 min read
A claims processor is responsible for reviewing insurance claims and determining whether they should be approved or denied. They may also be responsible for negotiating settlements with claimants.
Claims Processor job duties include:
- Reviewing and processing insurance claims in a timely manner
- Investigating and resolving claims
- Determining coverage and benefits
- Processing and issuing payments
- Coordinating with medical providers to obtain records
- Communicating with policyholders and claimants
- Maintaining claims records
- Adjusting claims as needed
- Referring complex claims to supervisors
Claims Processor Job Requirements
A Claims Processor is responsible for reviewing and processing insurance claims. They must have a high school diploma or equivalent, and some positions may require post-secondary education or certification. Claims Processors must have strong attention to detail and excellent communication skills. Previous experience in the insurance industry is preferred but not required.
Claims Processor Skills
- Communication
- Organization
- Time Management
- Customer Service
- Data Entry
- 10-Key
- Microsoft Office
- Filing
- Scanning
- Claims Processing
- Insurance
Related: Top Claims Processor Skills: Definition and Examples
How to become a Claims Processor
There are several steps that one must take in order to become a claims processor. The first step is to obtain the necessary education. Many claims processors have at least an associate’s degree, although some have bachelor’s degrees or higher. The second step is to obtain certification from the American Institute of Healthcare Claims Processing (AIHCP). The third step is to find employment with a company that processes insurance claims. Once employed, the fourth step is to complete on-the-job training. After completing these steps, one will be qualified to work as a claims processor.
The education requirements for claims processors vary by employer, but most employers prefer candidates who have at least an associate’s degree. Some employers may require candidates to have a bachelor’s degree or higher. Claims processors can obtain their education from many different types of institutions, such as community colleges, vocational schools, and online colleges.
The AIHCP offers certification for claims processors. To become certified, candidates must pass an exam that covers topics such as medical billing and coding, insurance policies, and claim processing procedures. Candidates can prepare for the exam by taking courses offered by the AIHCP or by studying on their own.
Employment opportunities for claims processors are available with insurance companies, hospitals, and other healthcare organizations. Many claims processors work remotely, which gives them the flexibility to work from home. To find employment, job seekers can search online job boards or contact companies directly.
Once employed, claims processors must complete on-the-job training. This training covers topics such as how to use the company’s claims processing system and how to handle different types of insurance claims. On-the-job training typically lasts for a few weeks or months. After completing on-the-job training, claims processors are typically able to work independently.
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