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Claim auditor vs compliance auditor

The differences between claim auditors and compliance auditors can be seen in a few details. Each job has different responsibilities and duties. Additionally, a compliance auditor has an average salary of $64,606, 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 a compliance auditor are audit findings, compliance audits, and audit reports.

Claim auditor vs compliance auditor overview

Claim AuditorCompliance Auditor
Yearly salary$46,802$64,606
Hourly rate$22.50$31.06
Growth rate6%6%
Number of jobs22,06833,704
Job satisfaction--
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 63%
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 a compliance auditor do?

A compliance auditor is responsible for reviewing the company's policies and procedures, ensuring the organization's adherence to state and federal regulations. Compliance auditors inspect the operations of each department, adjusting internal guidelines as needed. They also inspect the condition of all facilities, including tools and equipment, network systems, and business operations. A compliance auditor mitigates risks by analyzing the operational processes and conducting a risk assessment study to prevent compliance issues that may pose a negative effect on the company's performance and stability.

Claim auditor vs compliance auditor salary

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

Claim AuditorCompliance Auditor
Average salary$46,802$64,606
Salary rangeBetween $34,000 And $64,000Between $45,000 And $92,000
Highest paying CitySan Francisco, CANew York, NY
Highest paying stateWashingtonNew Jersey
Best paying companyBerkshire HathawayPayPal
Best paying industryInsuranceFinance

Differences between claim auditor and compliance auditor education

There are a few differences between a claim auditor and a compliance auditor in terms of educational background:

Claim AuditorCompliance Auditor
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 63%
Most common majorBusinessBusiness
Most common collegeUniversity of PennsylvaniaUniversity of Pennsylvania

Claim auditor vs compliance auditor demographics

Here are the differences between claim auditors' and compliance auditors' demographics:

Claim AuditorCompliance Auditor
Average age4444
Gender ratioMale, 23.9% Female, 76.1%Male, 38.9% Female, 61.1%
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 compliance auditor 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

Compliance auditor example responsibilities.

  • Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
  • Identify any issues that do not conform to CFR, ICH guidelines and corporate expectations.
  • Research HIPAA information from CMS website in order to determine correct revisions for policies and procedures and develop company-wide communications.
  • Coordinate team meetings, maintain calendars, support team with PowerPoint presentations.
  • Prepare and perform in-house presentations (both in person and using JoinMe) using PowerPoint.
  • Evaluate the level of compliance with company policy, GAAP, contract requirements and applicable rules and regulations.
    • Show more

Claim auditor vs compliance auditor skills

Common claim auditor skills
  • Medical Terminology, 9%
  • Medicaid, 8%
  • Patients, 6%
  • HCPCS, 5%
  • CMS, 5%
  • Audit Findings, 5%
Common compliance auditor skills
  • Audit Findings, 7%
  • Compliance Audits, 7%
  • Audit Reports, 6%
  • Audit Results, 4%
  • CPT, 4%
  • Compliance Program, 4%

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Updated January 8, 2025

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