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Occupation Info

Medical Insurance Claims Analyst

Overview: Medican Insurance claims analysts evaluate and decide the amount of insurance benefits to be paid to medical patients based upon the medical diagnosis and treatments they received. For ambiguous medical cases, they contact the physicians, hospitals or patients.
Duties: They analyze patient's requests for payment of insurance benefits for medical services they received. They decide what medical category each request fits into in order to decide upon payments.

In patient's cases where the diagnosis or treatments are unclear or not compatible with medical record classification schemes, they contact physicians, hospitals, or patients involved.

They use computer system software to compute the amount of insurance benefits to be paid to the patient and prepare printed checks and documents required.

Participate in insurance task force teams to recommend changes needed in medical classification schemes in order to improve the accuracy of classifying patients' diagnoses and treatments.

Degree(s): A.S. Health Sciences 
A.S. Liberal Arts and Sciences (Mathematics and Science) 
Job Outlook: Employment of medical insurance claims analysts is expected to grow as fast as average through 2018 spurred by the growth of the health insurance industry. There is a greater need for claims analysts to more scrupulously review a growing number of medical claims. Demand for these jobs will increase despite technology because many tasks cannot be easily automated.
Salary Range (National Average): $28,000 to $33,000
Education Level: Training for this occupation generally requires an Associate Degree from a 2 year or community college.
Additional Training/Education: Most insurance companies prefer to hire graduates with an associate or bachelor's degree and a curriculum background in insurance, business administration and economics. Certification can be achieved through a variety of professional associations in the insurance industry. Many insurance companies offer on-the-job training.
Recommended Skills:
  • Weighing out the options in a situation or a problem and logically choosing the best course of action.
  • Paying attention to what other people are saying, and taking time to understand the points being made.
  • Allocating and budgeting your time for different tasks so that things get done when needed.
  • Bringing people together to discuss and resolve differences.
  • Being aware of the reactions of others, and understanding why they react the way they do.
  • Persuading, encouraging and motivating others to accept your ideas.
  • The ability to understand complex written paragraphs, instructions, or reports.
  • Using logic to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
  • Talking, giving speeches, or speaking in a group to convey information, explain ideas, or give instructions.
  • Composing and communicating your ideas in written form.
Recommended Values:
  • Having a routine job where the duties are very predictable and not likely to change over a long period of time.

* National data collected by the Department of Labor between 2008-2012.
* For New York salary data information please click here
* For New York green job information please click here.

Understanding acquiring positions in this field may be enhanced through continuing academic study (i.e. earning a baccalaureate or a master's degree) and/or work experience in the field, Queensborough Community College has established transfer agreements with other institutions for students who wish to further pursue their educational goals. Students are highly encouraged to meet with one of our Career Services Advisor to fully understand the opportunities available through study in their degree program.