Today's health service is funded by insurance companies, and as a part of their processes of due diligence, they have to be able to check that claims made on their insurance policies are valid and reasonable. To be able to carry out this function, health insurance companies employ health claims examiners.
If you want to become a health claims examiner, you will need to train on a specialist program. Most insurance companies prefer to employ graduates in an appropriate subject, probably a medical related degree, and then take a training program on health insurance coding and billing. You will also have to be able to communicate well with others, as a part of your job as a health claims examiner will be to work with claimants and other witnesses, and insurance professionals. You will also find that you need to have a program of continuing education, as both the health and medical field, and the field of insurance are subject to constant change and it is a part of your job to be familiar with these changes.
Your career as a health claims examiner will involve both routine checking on claims and also looking at disputed claims, examining them for mistaken or fraudulent treatments and charges. You may find that you can help to negotiate settlements that are fair to both parties, and as you progress in your career, you can help to lay down the guidelines that are the basis of the transactions for the health funding system.
Publish date: February 10, 2011