How do I Become a Claims Adjudicator?

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  • Written By: Jill Gonzalez
  • Edited By: Michelle Arevalo
  • Last Modified Date: 14 November 2019
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In order to become a claims adjudicator in the United States, you should have a high school diploma or a general equivalency diploma (GED). Some employers may indicate a preference for candidates who have at least attended college, but a degree is usually not required. Although it is not generally necessary for candidates to have any type of license or certification, you should keep in mind that some employers may require applicants to be a certified pharmacy technician or bookkeeper.

For the most part, employers typically require applicants to have a certain amount of experience in the medical field. Previous experience that may help you to get hired might include work with government-sponsored health care programs, handling billing in a doctor's office, or in hospital administration. In some cases, employers may prefer to hire candidates who have worked handling medical claims in some manner for at least one to two years. Some companies might also have a preference for individuals who have worked in a pharmacy in some capacity.


A large part of this job usually involves dealing with customers. If you want to become a claims adjudicator, you should be able to talk and listen to people respectfully. You could have to deal with people who are upset or frustrated from time to time, so if you can handle this kind of activity calmly and tactfully, you may have an advantage. As you are being considered for some jobs, employers might ask you to demonstrate how you would handle certain situations. You should be prepared for this before going to a job interview.

You should have an aptitude for conducting research if you want to become a claims adjudicator. You may be responsible for investigating some claims, which could require you to ask questions that could make you uncomfortable. If you have the ability to separate your personal feelings from the duties of your job, you might be well suited to this type of work.

Some employers may require you to perform a certain amount of bookkeeping or other light accounting work as a regular part of your job. Therefore, it could be beneficial for you to have some basic work experience in one of these fields, or to take a few accounting or bookkeeping classes. If you want to become a claims adjudicator, and you do not have this kind of training or educational background, you should at least be comfortable working with numbers.


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