A denial is not resolved by software. Somebody reads the remittance, pulls the chart, finds the coverage rule, drafts the argument, and routes it to the payer. Across the industry that somebody sits in a shrinking set of job titles — billing clerks, medical records specialists, claims-processing staff — and the volume of work landing on them is going the other way. Experian’s revenue-cycle respondents put the denial burden on a clean upward line: 30% of providers reported one in ten claims denied in 2022, 38% in 2024, 41% in 2025.1 The headcount that absorbs it is not climbing to match.
This is the labor-market reading of the denial problem, and it is a simpler story than most: the burden is a rising line, the workforce is a flat one, and the space between them has to be filled by something. What fills it is triage — the quiet decision about which claims get worked and which get written off.
43%1
of surveyed revenue-cycle teams report being understaffed (2025)
~150k3
providers left the profession in 2022, per the study CAQH's Index cites
0%5
projected growth in billing and posting clerks, 2024–34 (BLS)
Two lines going opposite ways
The staffing pressure is not a forecast; it is already reported as a present condition. In Experian’s first State of Claims wave, in 2022, more than half of respondents said staff shortages were slowing claims submission.2 By the 2025 wave, 43% describe their teams as understaffed — while the same survey finds 90% of denied claims still pass through human review before resubmission.1The denial burden lands, almost entirely, on the people there are fewer of.
The exodus underneath that is measurable. The 2023 CAQH Index — the industry’s standard accounting of administrative transactions — cites a study finding that almost 150,000 providers left the profession in 2022, and attributes the resulting turnover and hiring difficulty directly to slower administrative workflows.3 Set the burden series against the workforce series and the shape is a pair of scissor blades:
Both series indexed to 100 at their base year, so the widening gap — not the units — is the reading.
Burden blade: Experian State of Claims, share of providers reporting 10%+ of claims denied, 30% (2022) → 38% (2024) → 41% (2025), indexed to 100 at 2022 (sources 1–2). Workforce blade: BLS projected headcount for billing and posting clerks (SOC 43-3021), 429,800 (2024) → 427,900 (2034), indexed to 100 at 2024 (source 5). The two series cover different windows and different units — this is a shape comparison, not a shared axis. Y-axis is an index, truncated to 92–145 for legibility.
“One recent study found that almost 150,000 providers left the profession in 2022. Increases in staff turnover and difficulties hiring replacements continued to place pressure on the administrative workflow.”3
2023 CAQH Index, citing Definitive Healthcare, “Addressing the healthcare staffing shortage” (Sept 2023)
Who actually does this work
“Working a denial” is not one job. It spans a few occupations the Bureau of Labor Statistics counts separately — the biller who reworks the claim, the records specialist who pulls the documentation, the clerk who processes the resubmission. Their pay is modest and their projected growth is flat or negative even as healthcare demand rises. BLS attributes the drag to automation: for billing clerks, it expects demand “to rise in fast-growing healthcare industries,” but automated processing software to “increase the productivity of these workers and reduce overall employment growth.”5
| Occupation (BLS SOC) | Employed, 2024 | Median wage (2024) | Projected 2024–34 |
|---|---|---|---|
| Medical records specialists · 29-2072 | 194,800 | $50,250 | +7% (+13,800)4 |
| Billing & posting clerks · 43-3021 | 429,800 | $47,170 | 0% (−1,900)5 |
| Insurance claims & policy clerks · 43-9041 | 256,700 | — | −4% (−9,500)5 |
| Financial clerks, all · 43-3000 | 1,193,000 | $48,650 | −5% (−58,300)5 |
BLS Occupational Outlook Handbook, 2024–34 projections; employment counts and median annual wages are May 2024 (sources 4–5). The billing-clerk wage $47,170 is BLS's occupation-specific median within the financial-clerk group; the $48,650 is the group median. Only medical records specialists — a coding/records role — is projected to grow; the clerical roles that resubmit and process claims are flat to falling.
The one occupation projected to grow, medical records specialists, is the coding-and-records role — and even there BLS notes that AI-based coding tools are expected to moderate demand.4 The roles that actually push a denied claim back through the system — the billing and claims clerks — are the ones held flat or cut. Healthcare and social assistance already employs 18% of all financial clerks, the second-largest industry for the occupation, so this is not a distribution the sector can escape by hiring elsewhere.5
What the gap actually does
A rising line and a flat line do not stay unreconciled. The capacity that is not there gets rationed, and the rationing has a name in every billing office: triage. High-value claims get worked; low-value ones get a glance and a write-off. The result is the same statistic that shows up wherever this workload is measured from the other end — the industry’s own estimate is that up to 65% of denied claims are never resubmitted at all.6 Not because they would lose on the merits — when providers do fight, they win a majority of the time7 — but because there is no hour left to fight them in.
That is the honest shape of the problem, and it does not have a staffing answer. You cannot hire the gap closed against a labor market that is flat-to-shrinking and getting more expensive; the median biller earns roughly $47,000 and the projected headcount for the role is zero-growth through 2034.5The only variable that moves the triage line is the cost of working a single denial. When that cost falls, the threshold of “worth fighting” falls with it, and claims that were rational to abandon become rational to contest — without adding a single person to the team. Which is the whole reason denial work is the first place automation gets pointed. The question this series leaves is narrower than the headlines: not whether the workforce that fights denials is shrinking — it is — but what carries the volume it can no longer reach.
Sources
- 1Experian plc — Experian Health's 3rd Annual State of Claims Survey Finds Denials Still on the Rise (43% understaffed; 41% report 10%+ denied; 90% of denials human-reviewed) · Sep 22, 2025
- 2Experian Health — New survey on denial management in healthcare (2022 State of Claims: staff shortages slowing claims submission) · Oct 27, 2022
- 32023 CAQH Index Report — “One recent study found that almost 150,000 providers left the profession in 2022” (citing Definitive Healthcare, Sept 2023) · Jan 2024 (2022 data)
- 4BLS Occupational Outlook Handbook — Medical Records Specialists (29-2072): 194,800 jobs, $50,250 median (2024); +7% projected 2024–34 · 2024–34 projections
- 5BLS Occupational Outlook Handbook — Financial Clerks (incl. Billing & Posting Clerks 43-3021: 429,800 jobs, $47,170 median, 0% projected; group −5%, 2024–34) · 2024–34 projections
- 6HFMA — Success in proactive denials management and prevention (up to 65% of denied claims never resubmitted) · series
- 7Premier — Trend Alert: private payers retain profits by refusing or delaying legitimate claims (54.3% of denials ultimately overturned) · Mar 2024 (2022 activity)