In the modern era, health insurance isn’t a luxury that only certain people should be able to afford: It’s a necessity. Health insurance is essential to maintaining the health of the population and treating illness and injury at prices that people can afford. Additionally, it enables people to receive important preventive care, such as screenings and vaccines; this means that health insurance affects public health just as it does personal health.
Considering the high demand for affordable health insurance and its critical role in maintaining the well-being of society, the role of health insurance claims management is significant for individuals and the overall economy. More than 85% of Americans had health insurance in 2021, according to the National Center for Health Statistics, a branch of the Centers for Disease Control and Prevention (CDC). Grand View Research reports that the health insurance market is predicted to rise more than 6% each year between 2020 and 2027.
Health insurance managers are integral to staying up to date on complex plans and insurance changes due to amended regulations. Although the job can be challenging, one way to ensure success is by investing in education, such as an Executive Master of Health Administration (MHA) degree program. This provides the solid educational foundation required to manage health care’s many complexities. An advanced degree can also directly influence a health insurance manager’s salary.
What Is a Health Insurance Manager?
Insurance claims managers oversee teams in insurance agencies that are responsible for logging and processing insurance claims. Health insurance managers fill the same role, but are limited to health claims. Because health insurance comes in various plans — each with evolving rules — keeping their team up to date so that claims are processed properly is a main responsibility of health insurance managers. They also perform the following duties:
- Consistently monitoring billing activities, claims processing agent performance and other relevant key performance indicators
- Providing expertise and guidance to claims processing teams, so they’re properly equipped to work with customers and process their claims
- Reviewing data for bill presentation (what customers see on their bills) and supervising the preparation process for accuracy and quality assurance
- Monitoring all regulations that may have an effect on how claims and billing are executed
- Vetting, hiring and coaching new members of the claims processing team
- Serving as liaisons between service providers, adjusters and clients
- Setting goals and expectations for the claims processing team
- Managing day-to-day operations
- Maintaining secure records of medical claims and other relevant documentation
- Assisting the legal team with preparing files in the event of a lawsuit or trial
- Handling escalated issues that the claims processing team can’t handle
- Preparing reports regarding performance for executive review
What Skills Does a Health Insurance Manager Need?
Health insurance managers need a specific skill set and knowledge to succeed. The following are the most in-demand attributes for this position:
- Comprehensive knowledge of county, state and federal health service codes
- Knowledge of basic medical terminology and medical coding
- Proficiency in the areas of analytics, accounts receivable, billing and the insurance claims process
- Proficiency in using health care claims management software
- Problem-solving and negotiating skills
- Excellent interpersonal and customer service skills
- Leadership and coaching skills
- Ability to multitask with great time management skills
- Strict attention to detail
Health Insurance Manager Salary and Job Outlook
Although education, experience and region influence health insurance manager salaries, current salary data can offer a general idea of compensation in the field.
The median annual salary for medical claims manager was approximately $73,000 in August 2022, according to Payscale, with the top 10% of earners making more than $103,000. General claims managers made a median annual salary of approximately $79,000, with the top 10% of earners making as much as $108,000.
According to the U.S. Bureau of Labor Statistics, job growth for claims adjusters, appraisers, examiners and investigators will decline in the coming years. However, despite this, there will still be around 23,200 job openings per year between 2021 and 2031.
Guide Health Insurance Procedures While Advancing Your Career
Quickly and efficiently processing claims allows patients to enjoy the service they expect from their insurance companies, while ensuring that health care facilities are compensated. The health insurance industry needs knowledgeable leaders who can monitor complex plans and regulations and efficiently manage a diverse workforce.
Those who aspire to become managers in the insurance field are encouraged to invest in education, such as the Executive MHA degree program at USC Price. With its comprehensive curriculum taught by industry professionals, the program is a good fit for those who aspire to become leaders in the field of health care. Find out how USC Price can help you take on new opportunities.
Recommended Readings
What Is Evidence-Based Practice in Health Care?
Women in Health Care Leadership: Past, Present and Future
Sources:
American Medical Association, Managing Patient Payments
Definitive Healthcare, Medical Claims 101: What You Need to Know
Glassdoor, Claims Manager Overview
Health Affairs, “Health Costs and Financing: Challenges and Strategies for a New Administration”
Health Payer Intelligence, Understanding the Complexity of Healthcare Claims, Payments
HealthCare Support, Healthcare Claims Manager
Houston Chronicle, “Definition of Medical Claims Management”
Investopedia, “Bill Presentment”
Payscale, Average Claims Manager Salary
Payscale, Average Medical Claims Manager Salary
U.S. Bureau of Labor Statistics, Claims Adjusters, Appraisers, Examiners, and Investigators