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Insurance Claim Specialist: An Overview

By Steve Smith

The information presented here is true and accurate as of the date of publication. DeVry’s programmatic offerings and their accreditations are subject to change. Please refer to the current academic catalog for details.
 

February 13, 2024
5 min read

There are different types of insurance coverage that exist to protect the things that are central to our lives, including life, home, auto, business and healthcare insurance.  Insurance shields ourselves and our loved ones when an accident or illness occurs, or when the roof – literally or figuratively – comes crashing down. You may not know much about the insurance industry or the professionals who work within it, but if you’ve registered a car, purchased or rented a house, visited the doctor or had any type of medical procedure, there is a good chance you’ve filed an insurance claim. But have you wondered what an insurance claim specialist is, and what they do?

In this article, we’ll discuss the role of the insurance claim specialist, doing our best to describe their duties and responsibilities, the role they play in the insurance industry and how what they do is related to medical billing and coding. We will also describe the skills you will need to demonstrate if you choose to prepare to pursue a career as a claims specialist.

What Does a Claims Specialist Do?

Claims specialists provide a vital administrative and customer support role related to the accurate and timely processing of insurance claims. They are involved in all phases of the process, from the initial intake of a claim through the final payout to the individual and/or service provider. In this capacity. Claims specialists often function as a liaison, facilitating communications between the insured party and the insurer, service provider or other parties that may be involved.

The regular duties performed by insurance claim specialists include:

  • Communicating with clients (the insured), insurers, service providers or other parties.

  • Examining insurance claims to uncover evidence of fraud.

  • Investigating insurance claims through interviews and assessments.

  • Researching the terms and stipulations of insurance policies and authorizing and processing claims once the amount of the claim payout has been determined.

  • Testifying in court, if called upon to do so.

  • Ensuring the timely distribution of funds to clients.

  • Researching the cost of medical treatments. 

Insurance Claim Specialist Skills

Because claims specialists perform such an important role and are often positioned as an intermediary between the various parties of an insurance claim, the ability to interact professionally with people is essential. Here are some of the skills you will need to cultivate as you prepare to pursue a career as an insurance claims specialist:

  • Verbal and written communication

    Claims specialists should be effective communicators, in both written and verbal formats. This is essential when providing courteous and articulate customer service with policyholders or negotiating with attorneys and colleagues. Written communications skills are useful to ensure clarity when documenting the details of an insurance claim.

  • Critical thinking and problem-solving

    Because claims specialists are called upon to assess the validity of insurance claims, it’s important for them to have the ability to analyze situations and make judgements using facts and logic. Problem-solving skills allow claims specialists to identify and solve problems effectively and enable them to resolve claims quickly and efficiently.

  • Organization

    To provide the best possible customer service and ensure accuracy, claims specialists need the ability to keep customer information, insurance information and any related documentation in a well-organized manner.

  • Time management

    Strong time management skills are another form of organization that enable claims specialists to organize their schedules in a way that uses time as efficiently as possible. This is crucial, considering the high volume of claims they are typically required to handle. 

  • Attention to detail

    This is another crucial skill that includes the ability to call out errors in documentation that may affect the handling or accuracy of a claim or hinder a claim-related investigation or negotiation.

Educational Requirements for the Insurance Claim Specialist

Based on the educational requirements included in typical job postings for insurance claim specialists, 73% of these professionals must enter the occupation with either a high school diploma/GED or a bachelor’s degree, though others may enter with an associate or master’s degree.

At DeVry, graduates of our online Undergraduate Certificate in Medical Billing and Coding may consider pursuing a career as an insurance claim specialist, after completing the program in as little as 10 months on an accelerated schedule, 1 year and 2 months on a normal schedule.1

1Normal schedule does not include breaks and assumes 2 semesters of year-round, full-time enrollment in 6-13 credit hours a semester per 12 month period. Accelerated schedule does not include breaks and assumes 3 semesters of year-round, full-time enrollment in 6-13 credit hours a semester per 12 month period.

The curriculum in this undergraduate certificate program can help you to form a well-rounded understanding of the terminology, coding practices and methodologies involved in the medical claims process. Topics covered in this hands-on program include medical terminology, medications and common abbreviations, health services and information systems, health insurance and reimbursement and payment methodologies. You’ll also be exposed to the International Classification of Diseases (ICD) system used to code medical diagnoses and procedures.

Insurance Claim Specialist Job Outlook

According to the U.S. Bureau of Labor Statistics (BLS), employment of medical records specialists, an occupation closely related to insurance claims specialists, is projected to grow 8% from 2022 to 2032, faster than the average for all occupations, with about 15,000 job openings projected each year, on average, over the decade.2 This growth is projected on a national level and local growth will vary by location. This projection is not specific to DeVry University graduates and may include earners at all stages of their careers.

In making their projection, the BLS attributes this job growth to an aging population’s increased need for medical services and a growing prevalence of chronic conditions such as heart disease and diabetes. Due to this, more medical professionals will be needed to manage patient data and coordinate services related to a patient’s insurance claim. 

DeVry Can Help You Prepare to Pursue a Career in the Insurance Industry

At DeVry, we offer a variety of health-focused academic degree and certificate programs in disciplines like health information technology, medical billing and coding, and healthcare administration that can be helpful at any stage of your career journey.

Our online Undergraduate Certificate in Medical Billing and Coding is a great place to start. You’ll work with simulated medical records in a web-based learning platform and prepare to pursue industry-relevant certifications. This program includes material addressed in the Certified Professional Coder (CPC) certification exam, or the Certified Coding Specialist (CCS) certification exam If you choose to enroll in our Medical Billing and Coding – Health Information Coding certificate program.

Study on your terms with DeVry. Our 6 academic sessions per year allow you to start when you’re ready and learn on your schedule, finishing on a regular or accelerated schedule that meets your personal and professional goals.

1Normal schedule does not include breaks and assumes 2 semesters of year-round, full-time enrollment in 6-13 credit hours a semester per 12 month period. Accelerated schedule does not include breaks and assumes 3 semesters of year-round, full-time enrollment in 6-13 credit hours a semester per 12 month period.

2https://www.bls.gov/ooh/healthcare/medical-records-and-health-information-technicians.htm Growth projected on a national level. Local growth will vary by location. BLS projections are not specific to DeVry University students or graduates and may include earners at all stages of their career and not just entry level.

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