Claim auditor vs audit specialist

The differences between claim auditors and audit specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, an audit specialist has an average salary of $58,291, which is higher than the $46,802 average annual salary of a claim auditor.

The top three skills for a claim auditor include medical terminology, medicaid and patients. The most important skills for an audit specialist are audit reports, patients, and customer service.

Claim auditor vs audit specialist overview

	Claim Auditor	Audit Specialist
Yearly salary	$46,802	$58,291
Hourly rate	$22.50	$28.02
Growth rate	6%	6%
Number of jobs	22,068	40,071
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 45%	Bachelor's Degree, 55%
Average age	44	44
Years of experience	-	-

What does a claim auditor do?

A claims auditor is primarily in charge of processing and auditing claims in companies and other institutions, ensuring accuracy and smooth workflow. Their responsibilities include coordinating with staff to gather the necessary data, liaising with clients to identify their needs, assessing the eligibility and validity of claims, verifying payments, and maintaining records of all transactions. Furthermore, as a claims auditor, it is essential to ensure that all claims and payments are carried out in adherence to the company's policies and regulations.

What does an audit specialist do?

An audit specialist is responsible for evaluating the reports by a professional auditor that will assist in improving the growth of the organization to achieve its goals and objectives. Audit specialists aid in the development of the company by using a systematic approach to reach the goals set by the company. Primary responsibilities include operating complex and difficult audit projects and conducting audits of control, financial, and other operating records. Also, they develop, implement distinct audit strategies, programs, and procedures for intricate assignments.

Claim auditor vs audit specialist salary

Claim auditors and audit specialists have different pay scales, as shown below.

	Claim Auditor	Audit Specialist
Average salary	$46,802	$58,291
Salary range	Between $34,000 And $64,000	Between $34,000 And $99,000
Highest paying City	San Francisco, CA	San Francisco, CA
Highest paying state	Washington	California
Best paying company	Berkshire Hathaway	SAP
Best paying industry	Insurance	Professional

Differences between claim auditor and audit specialist education

There are a few differences between a claim auditor and an audit specialist in terms of educational background:

	Claim Auditor	Audit Specialist
Most common degree	Bachelor's Degree, 45%	Bachelor's Degree, 55%
Most common major	Business	Business
Most common college	University of Pennsylvania	University of Pennsylvania

Claim auditor vs audit specialist demographics

Here are the differences between claim auditors' and audit specialists' demographics:

	Claim Auditor	Audit Specialist
Average age	44	44
Gender ratio	Male, 23.9% Female, 76.1%	Male, 33.7% Female, 66.3%
Race ratio	Black or African American, 8.6% Unknown, 4.0% Hispanic or Latino, 10.9% Asian, 12.2% White, 63.9% American Indian and Alaska Native, 0.5%	Black or African American, 8.7% Unknown, 4.0% Hispanic or Latino, 11.1% Asian, 12.1% White, 63.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	7%

Differences between claim auditor and audit specialist duties and responsibilities

Claim auditor example responsibilities.

Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
Bill and prepare claims appeals for Medicare, Medicaid, and private payers.
Review medical records and charges of hospital, ambulatory surgery and physician bills to verify CPT, ICD-9 and HCPCS codes.
Research and determine accuracy of ICD-9 and CPT codes on CMS 1500 and UB 92 claims forms on a daily basis.
Evaluate DRG grouping and pricing information.
Audit all claims types for a Medicare HMO plan.

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Audit specialist example responsibilities.

Manage vendor billing disputes for southwestern region from initiation to documentation of resolution while ensuring compliance with SOX guidelines.
Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
Review and verify the submitted documentation for completeness to verify the company is in compliance with Sarbanes-Oxley (SOX).
Coordinate delivery of mortgage back securities with internal and external stakeholders.
Monitor and maintain automated report generation and distribution via Cognos NoticeCast.
Prepare monthly incentive payment and quarterly incentive bonus data for payroll department.

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Claim auditor vs audit specialist skills

Common claim auditor skills

Medical Terminology, 9%
Medicaid, 8%
Patients, 6%
HCPCS, 5%
CMS, 5%
Audit Findings, 5%

Common audit specialist skills

Audit Reports, 11%
Patients, 8%
Customer Service, 7%
Internal Audit, 6%
Audit Findings, 5%
Process Improvement, 4%

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Updated January 8, 2025

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