Claim auditor vs quality control auditor

The differences between claim auditors and quality control auditors 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 $35,806 average annual salary of a quality control auditor.

The top three skills for a claim auditor include medical terminology, medicaid and patients. The most important skills for a quality control auditor are quality control audits, quality checks, and FHA.

Claim auditor vs quality control auditor overview

	Claim Auditor	Quality Control Auditor
Yearly salary	$46,802	$35,806
Hourly rate	$22.50	$17.21
Growth rate	6%	6%
Number of jobs	22,068	98,389
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 45%	Bachelor's Degree, 47%
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 a quality control auditor do?

A quality control auditor is in charge of auditing and evaluating quality control procedures to ensure operations adhere to company standards and budgets. Most quality control auditors work in manufacturing companies or warehouses where their responsibilities include conducting research and analysis to develop test structures for quality control, reviewing documentation and specifications, monitoring the performance of the workforce, performing risk assessments, and maintaining records. There are also times when a quality control auditor develops reports and presents them to managers, along with recommendations against vulnerable areas.

Claim auditor vs quality control auditor salary

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

	Claim Auditor	Quality Control Auditor
Average salary	$46,802	$35,806
Salary range	Between $34,000 And $64,000	Between $24,000 And $53,000
Highest paying City	San Francisco, CA	Paterson, NJ
Highest paying state	Washington	New Jersey
Best paying company	Berkshire Hathaway	Stifel Financial
Best paying industry	Insurance	Finance

Differences between claim auditor and quality control auditor education

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

	Claim Auditor	Quality Control Auditor
Most common degree	Bachelor's Degree, 45%	Bachelor's Degree, 47%
Most common major	Business	Business
Most common college	University of Pennsylvania	Stanford University

Claim auditor vs quality control auditor demographics

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

	Claim Auditor	Quality Control Auditor
Average age	44	44
Gender ratio	Male, 23.9% Female, 76.1%	Male, 42.3% Female, 57.7%
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, 8.5% Unknown, 4.0% Hispanic or Latino, 10.9% Asian, 12.2% White, 64.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	7%	7%

Differences between claim auditor and quality control 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.

Quality control auditor example responsibilities.

Manage the collection, analysis and verification of managerial payroll information to detect fraud and/or unethical practices.
Conduct internal analysis /inspection to evaluate ISO and NEMA compliance.
Ensure facility-wide compliance to FDA and ISO quality process regulations.
Inspect vendors, contractor sites, control procedures, and processes ensuring compliance with applicable GMP regulations and procedures.
Perform routine production line GMP audits to ensure that all workers are in strict compliance with regards to food safety regulations.
Assist LIMS system administrator with implementation and troubleshooting.

Claim auditor vs quality control auditor skills

Common claim auditor skills

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

Common quality control auditor skills

Quality Control Audits, 11%
Quality Checks, 9%
FHA, 5%
Va, 5%
USDA, 4%
ISO, 4%

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Claim Auditor
Claim Auditor vs Quality Control Auditor

Updated January 8, 2025

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