How to Become a Medical Claims Processor

What is a Medical Claims Processor?

A medical claims processor manages insurance claims from patients in doctors' offices and insurance companies. It is the job of the claims processor to analyze and process the insurance claim, checking it for validity. Medical claims processors are not required to have any formal education, but some training courses may help them obtain voluntary certification.

What does a Medical Claims Processor do?

A medical claims processor validates the information on all medical claims from patients seeking payment from their insurance company. Claims must be thoroughly reviewed to ensure that there is no missing or incomplete information. In addition, a processor must keep meticulous records of claims and follow up on lapsed cases.

Medical claims processors are expected to have an extensive knowledge of medical terminology, as well as experience using a computer. Since medical claims processors must approve or deny payment to doctors, it is vital that they know how to correctly read and assess medical documents. Good communication skills are necessary to converse with doctors' offices or insurance companies if there is a problem with the claim.

Required Education and or Certification.

There are no set educational requirements for medical claims processors. Companies may provide on-the-job training, though some previous knowledge or courses in the field may be required to enter the profession. Some schools offer vocational training or certificate programs for claims processing, which may help to start or advance a career.

Explore our Medical Claims Processor Training.

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You can also Live Chat, email, or call our center 412-920-5100 and learn how we can help you achieve your Medical Claims Processor goals!


Skills needed to become a Medical Claims Processor


These are the 5 essential skills every Medical Claims Processor needs to have if you want to excel!

  1. IT Knowledge
  2. Healthcare Information Management
  3. Soft Skills
  4. Problem Solving Skills
  5. Time Management Skills


A Day In The Life Of A Medical Claims Processor


Work Environment

A normal day in the life of a Medical Claims Processor does not very too much. A Medical Biller will generally complete tasks in the same series of areas each day as they pertain to medical documents. Medical Claim Processors should also be prepared to be in constant contact with doctors and insurance companies.

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New Horizons has trained employees at all 100 companies listed in Fortune magazine’s ranking of America’s 100 largest corporations and over half of the Global 100. We are ranked in the top 5% of the industry for training quality and customer satisfaction as reported by an independent, third-party learning and quality assurance company, Knowledge Advisors. Training from New Horizons provides measureable results.