Claims and Denials Specialist

Career Guide

A Claims and Denials Specialist helps a healthcare organization get paid correctly by submitting insurance claims, tracking payments, and appealing claim denials. The role focuses on accuracy, follow-up, and clear communication with insurance companies, patients, and internal clinical and billing teams.

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Key Responsibilities

Review patient and insurance information for claim accuracy
Submit claims to insurance payers on time
Monitor claim status and payment progress
Investigate denied or underpaid claims to find root causes
Prepare and submit appeals with supporting documentation
Request corrections to coding or documentation when needed
Post payments and adjustments when assigned
Communicate with insurance representatives to resolve issues
Update accounts and notes in billing systems and claim portals
Track denials trends and share findings with leaders
Follow privacy and security rules for patient information
Support patient inquiries about insurance status and balances

Top Skills for Success

Attention to Detail

Written Communication

Phone Communication

Time Management

Problem Solving

Customer Service

Medical Billing Knowledge

Insurance Benefits Knowledge

Denials Management

Appeals Writing

Claim Follow-up

Payment Posting

Coding Basics

Revenue Cycle Knowledge

Electronic Health Record Familiarity

Billing Software Proficiency

Data Entry Accuracy

Reporting and Tracking

Compliance Awareness

Career Progression

Can Lead To

Billing Specialist

Denials Analyst

Payment Poster

Patient Accounts Specialist

Collections Specialist

Authorization Specialist

Transition Opportunities

Revenue Cycle Analyst

Claims Supervisor

Billing Team Lead

Revenue Cycle Manager

Compliance Specialist

Medical Coding Specialist

Healthcare Operations Specialist

Common Skill Gaps

Often Missing Skills

Appeals documentation qualityRoot cause analysis for denialsPayer policy knowledgeReporting and trend trackingBilling system efficiencyCoding fundamentalsNegotiation and escalation skills

Development SuggestionsBuild a personal denial playbook by payer, track denial reasons weekly, and practice writing clear appeal narratives. Ask to shadow coding and authorizations teams to understand upstream causes. Create simple reports that show denial volume, denial rate, and recovery amount to demonstrate impact.

Market Intelligence Report

Claims and Denials Specialist is part of the Clinical Administration category.Explore our market intelligence report to see how AI and hiring demand are shifting for these roles.

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Salary & Demand

Median Salary Range

Entry Level$40,000 to $50,000

Mid Level$50,000 to $62,000

Senior Level$62,000 to $78,000

Growth Trend

Steady demand. Hiring remains consistent due to complex insurance rules, ongoing claim volume, and the need to reduce denied claims and speed up cash collection.

Companies Hiring

Major Employers

Hospital systemsMedical groupsHealth systemsDental service organizationsRevenue cycle management companiesMedical billing servicesInsurance companiesThird-party administrators

Industry Sectors

HospitalsClinicsPhysician practicesDental practicesBehavioral health providersHome health providersLaboratoriesImaging centersHealth insurance

Recommended Next Steps

Learn the top denial reason codes used by your payers and how to prevent them

Create a repeatable appeal template library and keep it updated

Set daily follow-up targets for aging claims and document outcomes consistently

Partner with coding and clinical documentation teams to reduce preventable denials

Take a medical billing or revenue cycle course to strengthen foundations

Practice using basic spreadsheets to track worklists and results

Request ownership of a payer portfolio to build expertise and measurable outcomes

Update your resume with metrics such as appeal win rate, dollars recovered, and reduction in denial rate