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Certification specialist vs claim specialist

The differences between certification specialists and claim specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, a certification specialist has an average salary of $45,265, which is higher than the $43,164 average annual salary of a claim specialist.

The top three skills for a certification specialist include patients, medical terminology and surgical procedures. The most important skills for a claim specialist are customer service, litigation, and patients.

Certification specialist vs claim specialist overview

Certification SpecialistClaim Specialist
Yearly salary$45,265$43,164
Hourly rate$21.76$20.75
Growth rate11%-6%
Number of jobs43,56529,505
Job satisfaction--
Most common degreeBachelor's Degree, 58%Bachelor's Degree, 54%
Average age4444
Years of experience-6

What does a certification specialist do?

A certification specialist is primarily in charge of conducting inspections and assessments, ensuring operations and procedures comply with certification guidelines and requirements. Although their responsibilities may vary upon their industry or organization of employment, it usually entails reviewing certification applications and system plans, arranging schedules and tests, organizing orientations, providing advice or guidance to new members of the workforce, and implementing strategies. Moreover, they also perform administrative support tasks such as processing the necessary documents, facilitating activities, and coordinating with internal and external parties.

What does a claim specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

Certification specialist vs claim specialist salary

Certification specialists and claim specialists have different pay scales, as shown below.

Certification SpecialistClaim Specialist
Average salary$45,265$43,164
Salary rangeBetween $25,000 And $81,000Between $27,000 And $67,000
Highest paying CityNew York, NYNewark, NJ
Highest paying stateNew YorkNew Jersey
Best paying companyAppleW. R. Berkley
Best paying industryInsuranceInsurance

Differences between certification specialist and claim specialist education

There are a few differences between a certification specialist and a claim specialist in terms of educational background:

Certification SpecialistClaim Specialist
Most common degreeBachelor's Degree, 58%Bachelor's Degree, 54%
Most common majorBusinessBusiness
Most common collegeWestern Carolina UniversityStanford University

Certification specialist vs claim specialist demographics

Here are the differences between certification specialists' and claim specialists' demographics:

Certification SpecialistClaim Specialist
Average age4444
Gender ratioMale, 26.3% Female, 73.7%Male, 31.0% Female, 69.0%
Race ratioBlack or African American, 6.4% Unknown, 4.6% Hispanic or Latino, 9.4% Asian, 8.8% White, 70.4% American Indian and Alaska Native, 0.4%Black or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%
LGBT Percentage11%10%

Differences between certification specialist and claim specialist duties and responsibilities

Certification specialist example responsibilities.

  • Support ISO audits for process documentation and software/ literature distribution, managing follow-up corrective action plans as needed.
  • Pre-Certify and scheduling of MRI's and bone scans.
  • Order supplies, apply cast, splints and other orthopedic equipment.
  • Prepare, apply, remove and adjusts casts and splints as advised by physician.
  • Review medical records to determine ICD-9 diagnosis and procedure codes according to establish guidelines and submit claims for processing.
  • Assign ICD-9 codes for various clinic types such as physical, occupational and speech therapies, diagnostics and labs.
  • Show more

Claim specialist example responsibilities.

  • Assist in the streamlining of EDI process to manage workflow of EDI claims.
  • Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
  • Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
  • Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
  • Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
  • Manage expedition of appeals via problem solving and collaboration with other departments.
  • Show more

Certification specialist vs claim specialist skills

Common certification specialist skills
  • Patients, 22%
  • Medical Terminology, 8%
  • Surgical Procedures, 6%
  • Medicaid, 5%
  • Data Entry, 4%
  • Certification Process, 4%
Common claim specialist skills
  • Customer Service, 19%
  • Litigation, 7%
  • Patients, 5%
  • Claims Handling, 4%
  • Quality Standards, 4%
  • Excellent Organizational, 4%

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