Claim investigator vs claim processor

The differences between claim investigators and claim processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become a claim investigator, becoming a claim processor takes usually requires 4-6 years. Additionally, a claim investigator has an average salary of $49,415, which is higher than the $41,201 average annual salary of a claim processor.

The top three skills for a claim investigator include scene investigations, insurance claims and property damage. The most important skills for a claim processor are customer service, data entry, and medical terminology.

Claim investigator vs claim processor overview

	Claim Investigator	Claim Processor
Yearly salary	$49,415	$41,201
Hourly rate	$23.76	$19.81
Growth rate	-6%	-6%
Number of jobs	8,738	11,542
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 43%
Average age	44	44
Years of experience	4	6

What does a claim investigator do?

Claim Investigators are professionals who are responsible for examining facts of insurance claims to determine their extent and validity to prevent any cases of fraud. These investigators must use a combination of tools such as cutting-edge software to help insurance companies to settle claims quickly by evaluating them. They are required to manage multiple cases by investigating defective products or events such as an oil spill. Claim Investigators must also prepare reports while keeping track of evidence trails.

What does a claim processor do?

A Claims Processor is responsible for processing and verifying insurance claims, in adherence to the policies, laws, and regulations of the company involved. Aside from examining its authenticity, they must also oversee new policies and recommend modifications should it be needed. Moreover, it is also the task of the Claims Processor to prepare the necessary documents and guidelines for the policyholder, process reimbursements upon approval, provide answers to inquiries, and report issues and updates to the management.

Claim investigator vs claim processor salary

Claim investigators and claim processors have different pay scales, as shown below.

	Claim Investigator	Claim Processor
Average salary	$49,415	$41,201
Salary range	Between $37,000 And $65,000	Between $26,000 And $62,000
Highest paying City	San Francisco, CA	Columbia, MD
Highest paying state	Alaska	Connecticut
Best paying company	Health Alliance	NTT Data International L.L.C.
Best paying industry	Finance	Insurance

Differences between claim investigator and claim processor education

There are a few differences between a claim investigator and a claim processor in terms of educational background:

	Claim Investigator	Claim Processor
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 43%
Most common major	Criminal Justice	Business
Most common college	California State University - Bakersfield	Stanford University

Claim investigator vs claim processor demographics

Here are the differences between claim investigators' and claim processors' demographics:

	Claim Investigator	Claim Processor
Average age	44	44
Gender ratio	Male, 52.5% Female, 47.5%	Male, 22.9% Female, 77.1%
Race ratio	Black or African American, 11.1% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.1% American Indian and Alaska Native, 0.5%	Black or African American, 11.2% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim investigator and claim processor duties and responsibilities

Claim investigator example responsibilities.

Manage and dispose of claims in litigation by preparing and developing strategy with defense counsel and consensus relative to litigation handling.
Coordinate with SIU investigators in their investigations of the same claimant or insure.
Collaborate with SIU, fire, and police personnel in an effort to resolve investigations.
Conduct extensive field investigations and interact with staff attorneys on litigation matters.
Prepare and/or review property and content estimates for settlement using Xactimate and XactContents software programs.
Conduct complete assessment of interior and exterior damage to create a detail repair estimate within Xactimate software.

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Claim processor example responsibilities.

Experience in many facets of the managed healthcare insurance business.
Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Use ICD-9, CPT-4 and other medical manuals to adjudicate claims.
Analyze claims submit by providers and facilities for appropriate ICD-9, CPT and HCPCS codes against charges that are being bill.
Call DME and HME companies to correct invoices.
Coach and assist in the training of new EMR databases.

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Claim investigator vs claim processor skills

Common claim investigator skills

Scene Investigations, 11%
Insurance Claims, 7%
Property Damage, 5%
Fraud Claims, 5%
Background Checks, 5%
Litigation, 4%

Common claim processor skills

Customer Service, 20%
Data Entry, 8%
Medical Terminology, 5%
CPT, 5%
Claims Processing, 4%
Medical Insurance Claims, 4%

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Updated January 8, 2025

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