Start a Medical Claims Evaluation Business

Harnessing Your Inner Sherlock: Unraveling Medical Billing Mysteries

person sitting while using laptop computer and green stethoscope near

Camera Icon National Cancer Institute / Unsplash

Medical Claims Evaluation Business - Picture Yourself

Kickstart your entrepreneurial journey with a Medical Claims Evaluation Business - the unseen superheroes of the healthcare system! Your venture will be the spearhead in analyzing, assessing, and confirming the validity of medical claims. As you sail on this journey, you will act as the essential intermediating layer between healthcare providers, patients, and insurance companies, ensuring medical billing accuracy and fairness. It's time to don your detective hat, harness your investigative skills, and protect the world from fraudulent, erroneous, or overpriced medical claims.

Grab Your Business Website Name

Before you get caught up in the whirlwind of setting up your business, invest in a domain name. It's a small but significant step that lays the foundation for your brand and makes it easier for customers to find and trust you. Just like you wouldn't build a house without securing the land first, don't build a business without securing your domain name.


Your domain name is more than just a web address; it's an essential part of your brand identity. It's what people will type into their browsers to find you. Securing a domain name that closely aligns with your business name helps you present a unified and professional image right from the get-go.


Having a domain name adds an element of legitimacy to your business. When consumers see that you have a dedicated domain name rather than a generic one (e.g.,, they're more likely to trust you. It's akin to having a business card versus scribbling your contact info on a piece of paper.

SEO (Search Engine Optimization)

Having your own domain name can benefit your SEO strategy. Search engines like Google give weightage to domain names when ranking websites. A domain name with keywords related to your business can help you rank higher in search results, thus bringing more eyeballs to your product or service.

Avoid Losing the Perfect Domain

Good domain names are like good real estate—they're in high demand and can get snapped up quickly. If you delay purchasing your domain name, you might find that someone else has grabbed it, and then you're either out of luck or need to negotiate to buy it at a much higher price.

Early Marketing

Once you have a domain name, you can start marketing your business—even before you launch. A "Coming Soon" page with an email capture can help you start building an audience. You can also set up professional email addresses (e.g.,, which can be used on business cards and in other preliminary marketing materials.


Owning your domain name gives you the flexibility to move your website to any hosting provider without losing your web address. It's like owning a piece of land where you can build, rebuild, or renovate your store as you please.


Compared to other startup costs, a domain name is relatively inexpensive. Yet, its value can be immense. For the cost of a few cups of coffee a year, you can secure a critical asset for your business.

Medical Claims Evaluation Quick Business Check

This a quick reality check to help you identify the strengths and weaknesses of your business concept before you dive in.

Expected Percent Margin:

  • Gross Margin: 60 - 70%
  • Net Profit Margin: 15 - 25%

Earnings Expectations:

  1. Daily Earnings: $500 - $1,000
  2. Weekly Earnings: $2,500 - $5,000
  3. Monthly Earnings: $10,000 - $20,000
  4. Annual Earnings: $120,000 - $240,000

Actions to Hit Those Numbers:

Licensing and Certification:
  • Initial Investment: Expect to invest up to $10,000 to obtain the necessary certifications and licensing.
  • Ongoing Education: Keep your credentials current by investing in continuing education.
Marketing and Customer Acquisition:
  • Networking: Engage with healthcare providers, attorneys and insurance companies - they are your potential clients.
  • Online Presence: Invest in an informative, SEO-optimized website and an active LinkedIn presence.
Service Provision:
  • Staffing: Hire experienced medical coders and claims evaluators to ensure accuracy and reduce liability.
  • Process: Implement a robust claims checking process to catch inaccuracies early.
Cost Control:
  • Office Space: Consider a home-based or virtual office to minimize rent expenses.
  • Outsource Non-Core Functions: Consider outsourcing administrative tasks to keep costs down.
Business Operations:
  • Client Relationships: Maintain good relationships with clients through outstanding customer service. Aim for long-term contracts as a regular source of business.
  • Volume of Claims: Aim to evaluate approximately 20-50 claims per day, depending on complexity, to achieve the expected daily earnings.

Bear in mind these are general estimates. Individual outcomes can vary widely depending on location, economic conditions, and individual business decisions. Consult with a financial advisor for personalized advice.

Step 1: Determine if the Business is Right for You

Breakdown of Startup Expenses

When starting a medical claims evaluation business, it is important to understand the startup costs associated with the venture. This includes the cost of office space, equipment, software, and any other necessary resources. Additionally, you should consider the cost of hiring staff, as well as the cost of marketing and advertising. It is important to have a clear understanding of the financial investment required to get the business off the ground.

Breakdown of Ongoing Expenses

Once the business is up and running, there are ongoing expenses to consider. These include the cost of supplies, salaries for staff, and any other recurring expenses. Additionally, you should consider the cost of insurance, taxes, and other legal fees. It is important to have a clear understanding of the financial commitment required to keep the business running.

Examples of Ways to Make Money

There are a variety of ways to make money with a medical claims evaluation business. One way is to offer consulting services to medical providers. This could involve helping them to understand the claims process, as well as providing advice on how to maximize their reimbursements. Additionally, you could offer services to insurance companies, such as helping them to identify fraudulent claims. You could also offer services to individuals, such as helping them to understand their medical bills and filing claims on their behalf.

Step 2: Name the Business

  1. Brainstorm ideas: Start by brainstorming ideas for the business name. Consider the type of business, the services it will offer, and the target audience.
  2. Research the name: Once you have a few ideas, research them to make sure they are not already taken. Check the USPTO website and other online resources to make sure the name is available.
  3. Consider the domain name: Once you have a few potential names, check to see if the domain name is available. This will be important for setting up a website and other online resources.
  4. Make sure the name is memorable: The name should be easy to remember and should evoke the type of business you are starting. Consider how it will look on business cards, letterheads, and other marketing materials.
  5. Get feedback: Once you have a few potential names, get feedback from family, friends, and potential customers. This will help you make sure the name is appropriate and resonates with the target audience.

Step 3: Obtain Necessary Licenses and Permits

Researching Licenses and Permits Needed

Before applying for any licenses or permits, it is important to research what is required for a medical claims evaluation business. Depending on the state and local laws, there may be different types of licenses and permits needed. It is important to research the specific requirements for the state and local area in order to ensure that all necessary licenses and permits are obtained. Additionally, it is important to research any other laws and regulations that may apply to the business.

Applying for Licenses and Permits

Once the necessary licenses and permits have been identified, the next step is to apply for them. This can be done through the local government office or online. It is important to ensure that all applications are filled out correctly and that all necessary documents are included. Additionally, it is important to pay any applicable fees in a timely manner. Once all applications have been submitted, it is important to follow up with the local government office to ensure that the applications have been received and are being processed.

Step 4: Create a Business Plan

Outlining Goals and Objectives

A business plan is a critical document that outlines the goals and objectives of the business. It should include a timeline for achieving those goals, a description of the services offered, and a financial plan. It should also include a market analysis and a competitive analysis. When outlining goals and objectives, it is important to be realistic and to set achievable goals. Consider the size of the business, the resources available, and the target market.

Establishing Financial Projections

Financial projections are essential for any business. They provide a roadmap for the business and help to determine if the business is viable. Financial projections should include an income statement, a balance sheet, and a cash flow statement. They should also include a break-even analysis and a budget. When creating financial projections, it is important to be realistic and to consider potential risks and opportunities. Consider the cost of materials, labor, and overhead expenses. Also, consider the potential for income and the potential for growth.

Step 5: Secure Funding

Sources of Financing

When starting a medical claims evaluation business, it is important to secure the necessary funding to get the business off the ground. There are several sources of financing available, including personal savings, credit cards, crowdfunding, angel investors, and venture capital. It is important to consider the pros and cons of each option before deciding which one is right for the business.

Applying for Loans and Grants

In addition to personal savings and other sources of financing, entrepreneurs may also consider applying for loans and grants to help fund their business. Government grants and loans are available to small businesses, and there are also private lenders and investors who may be willing to provide financing. It is important to research the different types of loans and grants available and to understand the terms and conditions associated with them before applying. Additionally, entrepreneurs should make sure they have a solid business plan and financial projections before applying for any type of loan or grant.

Step 6: Find a Location

Factors to Consider When Choosing a Location

When selecting a location for a medical claims evaluation business, there are several factors to consider. First, the business should be located in an area that is easily accessible to both clients and employees. It should also be in a location that is close to other medical businesses, such as hospitals, clinics, and pharmacies. Additionally, the business should be located in an area that is zoned for commercial use and has adequate parking. Finally, the business should be located in an area that is safe and secure.

Securing a Lease

Once a suitable location has been identified, the next step is to secure a lease. It is important to research the local market to determine the going rate for commercial leases in the area. Additionally, it is important to read the lease carefully and make sure that all terms and conditions are clearly understood. It is also important to negotiate the terms of the lease to ensure that the business is getting the best deal possible. Finally, it is important to ensure that the lease is properly documented and signed by both parties.

Step 7: Hire Employees

Determining Staffing Needs

When starting a medical claims evaluation business, it is important to determine the staffing needs for the business. This includes deciding how many employees are needed, what type of skills and experience they should have, and what roles they will be responsible for. It is important to consider the size of the business and the workload when determining staffing needs. Additionally, it is important to consider the budget for hiring employees and the cost of benefits and other expenses associated with hiring employees.

Recruiting and Interviewing Candidates

Once the staffing needs are determined, the next step is to begin recruiting and interviewing candidates. This includes creating job postings, searching for qualified candidates, and conducting interviews. It is important to create job postings that accurately describe the job responsibilities and qualifications. Additionally, it is important to create a list of questions to ask during the interview process to ensure that the candidate is the right fit for the position. It is also important to consider the candidate's experience, skills, and qualifications when making a hiring decision.

Step 8: Market Your Business

Developing a Marketing Plan

Before you can start marketing your medical claims evaluation business, you need to develop a marketing plan. This plan should include a budget for marketing, a timeline for when you plan to launch your marketing campaigns, and a list of tactics you plan to use. You should also include a list of goals for your marketing plan, such as increasing brand awareness and generating leads. Additionally, you should create a strategy for tracking the success of your marketing efforts.

Utilizing Online and Offline Strategies

Once you have developed a marketing plan, you can start to implement your marketing strategies. Online marketing tactics can include creating a website, launching a blog, and utilizing social media platforms. Offline marketing tactics can include attending networking events, advertising in local publications, and sending out direct mail campaigns. Additionally, you should consider utilizing search engine optimization (SEO) to help your website rank higher in search engine results. Finally, you should consider developing relationships with local healthcare providers and other medical professionals to help spread the word about your business.

Step 9: Maintain Records

Types of Records to Keep

It is important to maintain accurate records for a medical claims evaluation business. This includes keeping track of all financial transactions, such as income and expenses. Additionally, it is important to keep records of all client information, such as contact information, medical history, and any other relevant information. It is also important to keep records of any contracts or agreements made with clients. Finally, it is important to keep records of any certifications or licenses that are required to operate the business.

Software and Tools for Record Keeping

There are many software and tools available to help keep track of records for a medical claims evaluation business. These include accounting software, customer relationship management (CRM) software, and document management software. Accounting software can help keep track of income and expenses, while CRM software can help keep track of client information. Document management software can help keep track of contracts and agreements. Additionally, there are many other tools available to help keep track of records, such as spreadsheets and calendars.