Formal Education

• No standardized formal education requirements exist for a job as a health claims examiner; individual employers set their own hiring requirements. According to the U.S. Bureau of Labor Statistics, health care examiners need at least a high school diploma, but most employers prefer college graduates or those who have at least some vocational training and insurance-related background. Coursework in business, law, math, economics, medical billing, medical terminology and records is advised. Having a medical background is very useful for this career.
  
  

On-The-Job Training

• Health claims examiners typically receive most of their training on the job with an experienced worker, according to the BLS. They begin with basic, straightforward claims and slowly work their way up to more complex and risky claims. They receive feedback on their work and learn through observation, complementary coursework and organized training sessions. Trainees learn valuable skills, such as the ability to recognize a fraudulent claim, and report their findings to investigators. Training programs are generally paid.
  
  

Licensure

• Licensing requirements for this profession vary by state. In some cases you'll need to take a written licensing exam, complete a state-approved pre-licensing education curriculum or both, according to the BLS. In most states you'll need to take continuing education classes to maintain your license. This license may not be required by all employers but will provide you with greater career opportunities.
  
  

Essential Skills

• The job of a health claims examiner is not for everyone, and certain skills are required. Excellent communication skills, both written and verbal, are essential, as claims examiners spend a great deal of their time interacting with claimants, witnesses, insurance adjusters and other professionals. This includes good interrogation and interviewing skills. Claims examiners must be able to use computer applications used by their companies. Strong analytical and mathematical skills also are crucial.
  
  

Career Advancement

• Health claims examiners begin their careers at the bottom of the pecking order but can advance by displaying strong job performance, pursuing continuing education and obtaining advanced degrees. Those who perform well and go above and beyond their job requirements may be promoted to supervisory, managerial or senior claims examiner positions over time. These jobs pay better but demand more responsibility.