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Claim auditor vs quality assurance auditor

The differences between claim auditors and quality assurance auditors can be seen in a few details. Each job has different responsibilities and duties. Additionally, a quality assurance auditor has an average salary of $77,535, 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 quality assurance auditor are patients, ISO, and clinical trials.

Claim auditor vs quality assurance auditor overview

Claim AuditorQuality Assurance Auditor
Yearly salary$46,802$77,535
Hourly rate$22.50$37.28
Growth rate6%6%
Number of jobs22,06879,931
Job satisfaction--
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 55%
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 quality assurance auditor do?

Quality assurance (QA) analysts are responsible for testing company products and processes. Through testing, QA analysts ensure that the product or process is ready for production. They check whether the process meets company standards and guidelines, as well as any standards related to the industry they are in. QA analysts are in charge of determining the root cause of any problems that they may encounter. They also try to solve these as soon as possible. They also ensure that the company's products meet user expectations as well as the company's brand promise.

Claim auditor vs quality assurance auditor salary

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

Claim AuditorQuality Assurance Auditor
Average salary$46,802$77,535
Salary rangeBetween $34,000 And $64,000Between $49,000 And $122,000
Highest paying CitySan Francisco, CASan Francisco, CA
Highest paying stateWashingtonCalifornia
Best paying companyBerkshire HathawayRegeneron
Best paying industryInsurancePharmaceutical

Differences between claim auditor and quality assurance auditor education

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

Claim AuditorQuality Assurance Auditor
Most common degreeBachelor's Degree, 45%Bachelor's Degree, 55%
Most common majorBusinessBusiness
Most common collegeUniversity of PennsylvaniaStanford University

Claim auditor vs quality assurance auditor demographics

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

Claim AuditorQuality Assurance Auditor
Average age4444
Gender ratioMale, 23.9% Female, 76.1%Male, 46.0% Female, 54.0%
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, 8.6% Unknown, 4.0% Hispanic or Latino, 10.9% Asian, 12.2% White, 63.8% American Indian and Alaska Native, 0.5%
LGBT Percentage7%7%

Differences between claim auditor and quality assurance 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

Quality assurance auditor example responsibilities.

  • Manage post-audit activities and follow-up s on any necessary CAPA require resolving majority of deviations/investigations.
  • Lead cross functional project team to build user-friendly windows base customer support applications which interface with the OmniPlan/OmniPlus mainframe application.
  • Analyze and underwrite VA and FHA loans according to FNMA, FHLMC, regulatory and bank underwriting guidelines.
  • Educate staff and officers of third party lending partners on procedures and requirements for FHA, VA and USDA home loans.
  • Ensure loan documents are compliant with RESPA TILA guidelines.
  • Prepare correspondence; including TILA and RESPA disclosures, responding to OFAC queries and other OFAC relate matters.
    • Show more

Claim auditor vs quality assurance auditor skills

Common claim auditor skills
  • Medical Terminology, 9%
  • Medicaid, 8%
  • Patients, 6%
  • HCPCS, 5%
  • CMS, 5%
  • Audit Findings, 5%
Common quality assurance auditor skills
  • Patients, 10%
  • ISO, 7%
  • Clinical Trials, 5%
  • FDA, 5%
  • Quality Assurance Audits, 5%
  • GMP, 4%

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Updated January 8, 2025

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