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Claim auditor vs auditor/quality

The differences between claim auditors and auditors/quality can be seen in a few details. Each job has different responsibilities and duties. Additionally, a claim auditor has an average salary of $46,802, which is higher than the $35,312 average annual salary of an auditor/quality.

The top three skills for a claim auditor include medical terminology, medicaid and patients. The most important skills for an auditor/quality are excellent interpersonal, excellent organizational, and audit findings.

Claim auditor vs auditor/quality overview

Claim AuditorAuditor/Quality
Yearly salary$46,802$35,312
Hourly rate$22.50$16.98
Growth rate6%6%
Number of jobs22,06877,040
Job satisfaction--
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 39%
Average age4444
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 auditor/quality do?

A quality auditor is responsible for inspecting the company's services and products, ensuring its adherence to business requirements and internal regulations. Quality auditors analyze the efficiency of operational functions and production processes to maintain high-quality deliverables with the utmost consideration for the safety and security of the production staff. They run quality checks for the outputs, create findings reports, and strategize methodologies to enhance stability by utilizing standard testing parameters. A quality auditor must have excellent communication and organizational skills, as they may also recommend opportunities to generate more resources and increase revenues.

Claim auditor vs auditor/quality salary

Claim auditors and auditors/quality have different pay scales, as shown below.

Claim AuditorAuditor/Quality
Average salary$46,802$35,312
Salary rangeBetween $34,000 And $64,000Between $24,000 And $50,000
Highest paying CitySan Francisco, CAShelton, CT
Highest paying stateWashingtonNew Jersey
Best paying companyBerkshire HathawayMeta
Best paying industryInsuranceRetail

Differences between claim auditor and auditor/quality education

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

Claim AuditorAuditor/Quality
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 39%
Most common majorBusinessBusiness
Most common collegeUniversity of PennsylvaniaStanford University

Claim auditor vs auditor/quality demographics

Here are the differences between claim auditors' and auditors/quality' demographics:

Claim AuditorAuditor/Quality
Average age4444
Gender ratioMale, 23.9% Female, 76.1%Male, 44.8% Female, 55.2%
Race ratioBlack 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, 8.5% Unknown, 4.0% Hispanic or Latino, 10.8% Asian, 12.2% White, 64.1% American Indian and Alaska Native, 0.5%
LGBT Percentage7%7%

Differences between claim auditor and auditor/quality 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.
  • Show more

Auditor/quality example responsibilities.

  • Lead cross functional project team to build user-friendly windows base customer support applications which interface with the OmniPlan/OmniPlus mainframe application.
  • Identify patterns of repetitive QMs and report to management.
  • Attend Nordstrom department meetings.use RF device gun to scan merchandise, read retail report sheets.
  • Complete GMP compliance audits in accordance with standards define in internal and external audit procedures and requirements.
  • Complete and maintain accurate records of all quality assurance programs establish by the company and require by the FDA.
  • Maintain equipment calibrations and troubleshoot laboratory equipment.
  • Show more

Claim auditor vs auditor/quality skills

Common claim auditor skills
  • Medical Terminology, 9%
  • Medicaid, 8%
  • Patients, 6%
  • HCPCS, 5%
  • CMS, 5%
  • Audit Findings, 5%
Common auditor/quality skills
  • Excellent Interpersonal, 13%
  • Excellent Organizational, 10%
  • Audit Findings, 6%
  • Customer Service, 5%
  • Audit Results, 4%
  • Medicaid, 4%

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