Medical Claims Adjuster Jobs
What is a Medical Claims Adjuster?
A Claims Adjuster within the healthcare spectrum—often referred to as a Medical Claims Adjuster—is responsible for reviewing, investigating and resolving insurance claims related to medical services. Their primary goal is to ensure that claims are processed accurately, fairly and in accordance with policy terms and healthcare regulations.
What does a Medical Claims Adjuster do?
Key job responsibilities for a medical claims adjuster may include:
Review medical claims for accuracy, completeness and eligibility
Analyze medical records and billing codes to verify necessity and coverage
Determine the insurer’s liability and calculate appropriate reimbursement amounts
Investigate discrepancies or potential fraud in submitted claims
Communicate with healthcare providers, patients and insurance representatives
Negotiate settlements when needed and authorize payments
Maintain detailed documentation throughout the claims process
Stay current with healthcare policies, procedures and regulatory changes
How to Work as a Medical Claims Adjuster
A medical claims adjuster needs to have excellent written and verbal communication skills. Interpersonal relations are an important part of being a claims adjuster. However, it’s also important to have strong analytical skills since a big part of a claim adjuster’s job is scrutinizing medical bills. If you’re a person who has a knack for spotting errors in long lists, this would be a good career for you.
Skills and qualifications needed:
Proficient in medical terminology and billing codes
Strong understanding of health insurance policies and coverage
Detail-oriented with excellent analytical abilities
Comfortable using claims management software and databases
Effective written and verbal communication skills
Strong customer service and conflict resolution abilities
How to become a medical claims adjuster
To become a medical claims adjuster, you’ll generally need to have a bachelor’s degree in some sort of medical field. Along with this, you’ll often be required to have some level of healthcare experience. Depending on where you’re trying to work as a medical claims adjuster, you may even be required to carry some sort of license or certificate.
The first step on the path to becoming a medical claims adjuster is to choose which degree you’re going to get. Once you’ve got your degree, you should find a job in the healthcare field and start to build relevant experience. After you’ve got plenty of experience, you can earn any necessary licenses and certificates to become a medical claims adjuster.
Your Career, Your Way
At HealthCare Support, we don’t just help you find a job, we help you build a career that reflects your goals, values and potential. With a dedicated recruiting specialist by your side, our personalized hiring process is designed to uncover opportunities that truly fit. If you're ready to make a meaningful impact in healthcare and want a partner who’s invested in your success, HealthCare Support is where your journey begins.