Medical Claims Adjuster
If you’re looking for a career that combines analytical thinking, healthcare insight, and insurance expertise, then becoming a medical claims adjuster could be your perfect fit. These professionals help insurance companies review and process health-related claims efficiently and fairly.
At RS Thomas Training Associates, we’ve helped thousands of insurance professionals launch successful careers. With more than 50 years of experience, we’re ready to walk you through every step of the journey toward becoming a licensed medical claims adjuster.
What Does a Medical Claims Adjuster Do?
Before diving into the process, it’s important to understand the role. A medical claims adjuster examines health insurance claims submitted by patients and healthcare providers. They determine whether a policy covers the services and ensure providers accurately billed the procedures.
As a medical claims adjuster, you will:
- Review patient medical records and treatment plans
- Confirm policyholder coverage and benefit eligibility
- Investigate potential fraud or billing errors
- Communicate with providers, attorneys, and clients
- Calculate claim settlements according to state and policy rules
- Document your findings and resolutions thoroughly
This role requires you to master medical terminology, insurance contracts, and billing codes, and apply them to real-world scenarios.
Step-by-Step Guide: How to Become a Medical Claims Adjuster
Let’s walk through the steps you need to take to start this career.
1. Earn a High School Diploma or GED
Start by earning your high school diploma or GED. Strong skills in math, communication, computer literacy, and writing will prepare you for the claims environment.
2. Consider Earning a Postsecondary Degree (Optional but Helpful)
Next, think about pursuing an associate or bachelor’s degree in healthcare administration, nursing, insurance and risk management, or business. Employers often prefer candidates who understand healthcare systems and documentation processes.
When you study medical billing, anatomy, or health law, you’ll find it easier to assess medical claims accurately.
3. Enroll in a Pre-Licensing Course
Most states require you to complete a pre-licensing education program before taking the adjuster exam. These courses teach you how to:
- Interpret policies
- Apply state laws and ethics
- Understand claims handling
- Read medical documentation
- Detect fraud
At RS Thomas Training Associates, we’ve designed our pre-licensing programs to prepare you for both the exam and the day-to-day challenges of the profession. Our instructors bring real-world experience, and our coursework gives you hands-on knowledge.
4. Take and Pass the Adjuster Licensing Exam
Once you complete the course, you’ll take the state licensing exam. This exam measures how well you understand:
- Insurance terms and coverage types
- Claims investigation processes
- Healthcare documentation
- State-specific regulations
Your state’s Department of Insurance or designated testing provider will administer the exam. To improve your chances of passing on the first attempt, join our RS Thomas exam prep sessions, where we guide students through practice questions and exam strategies.
5. Apply for Your Adjuster License
After you pass the exam, go ahead and apply for your license. You’ll typically need to:
- Submit proof of education and exam completion
- Pay licensing fees
- Complete fingerprinting or a background check (depending on your state)
Once the state approves your application, they will issue your license and allow you to begin working legally as a medical claims adjuster.
6. Gain Hands-On Work Experience
Now that you’re licensed, start applying for entry-level positions like:
- Claims Assistant
- Claims Examiner
- Junior Medical Claims Adjuster
In these roles, you’ll handle documentation, follow up on claims, and support senior adjusters while you build confidence and industry knowledge. At RS Thomas Training, we make sure you graduate with practical skills that employers value—so you can step into your first role fully prepared.
7. Pursue Professional Certifications
If you want to grow in your career, you should pursue certifications that prove your expertise. Some great options include:
- AIC (Associate in Claims)
- AHIP Certifications
- CMSP (Certified Medicare Secondary Payer Professional)
- CPCU (Chartered Property Casualty Underwriter)
RS Thomas Training helps you identify the right certification based on your career path and prepares you to achieve it.
8. Complete Continuing Education (CE) to Maintain Your License
Most states require adjusters to complete continuing education every one or two years to renew their license. Through CE, you stay updated on:
- New laws and regulations
- Evolving healthcare systems
- Claim trends and fraud schemes
- Ethical standards
You can fulfill your CE requirements with RS Thomas’s online or in-person CE programs, which we tailor to meet state mandates while also deepening your expertise.
Why Should You Become a Medical Claims Adjuster?
Let’s take a closer look at why this career is both practical and rewarding.
✔ Consistent Demand
Insurance companies continue to hire medical claims adjusters to process increasing numbers of healthcare claims and combat fraud.
✔ Competitive Salary
According to the U.S. Bureau of Labor Statistics, claims adjusters earn a median salary of $72,000 per year, and experienced professionals often earn more than $90,000.
✔ Flexibility
Many adjusters now enjoy remote work or hybrid schedules, which makes work-life balance easier than ever.
✔ Meaningful Work
As an adjuster, you ensure people receive the benefits they deserve while helping insurers make fair decisions.
Explore Career Advancement Options
Once you gain experience, you can apply for higher-level roles such as:
- Senior Medical Claims Adjuster
- Claims Supervisor or Team Lead
- Fraud Investigator
- Healthcare Compliance Officer
- Risk Management Consultant
With advanced certifications, some professionals also move into auditing, consulting, or executive-level roles in insurance companies or healthcare firms.
Why Train With RS Thomas Training Associates?
At RS Thomas Training Associates, we don’t just help you pass exams—we help you build a lifelong career. Here’s why professionals trust us:
- We offer state-approved licensing and CE courses
- Our instructors bring decades of real-world experience
- You can choose online or in-person formats to fit your schedule
- We guide you through every step—from exam prep to CE
- We offer job-ready training, not just textbook knowledge
Thousands of successful professionals launched their careers with us—and now it’s your turn.
Final Thoughts: Take the First Step Toward a Rewarding Career
To sum up, medical claims adjusting is a high-demand, high-reward field that allows you to use both healthcare and investigative skills. If you want a career that offers stability, growth, and purpose, this is a smart choice.
And with RS Thomas Training Associates by your side, you’ll receive the education, support, and confidence you need to thrive in this competitive industry.
FAQs: Becoming a Medical Claims Adjuster
Q1: Do I need a medical background?
No. While medical experience helps, our training gives you all the tools you need to succeed.
Q2: How long does it take to get licensed?
Most students complete the process in 3 to 6 months, depending on their schedule and state requirements.
Q3: Can I work remotely as an adjuster?
Yes. Many companies now allow adjusters to work from home.
Q4: What’s the biggest advantage of RS Thomas Training?
We combine practical training, exam preparation, and career mentoring—all in one place.
Q5: Do your courses qualify for CE credits?
Absolutely. Our CE courses are approved in most states and designed to keep you compliant and competitive.