Claim investigator vs claim specialist

The differences between claim investigators and claim specialists 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 specialist takes usually requires 4-6 years. Additionally, a claim investigator has an average salary of $49,415, which is higher than the $43,164 average annual salary of a claim specialist.

The top three skills for a claim investigator include scene investigations, insurance claims and property damage. The most important skills for a claim specialist are customer service, litigation, and patients.

Claim investigator vs claim specialist overview

	Claim Investigator	Claim Specialist
Yearly salary	$49,415	$43,164
Hourly rate	$23.76	$20.75
Growth rate	-6%	-6%
Number of jobs	8,738	29,505
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 54%
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 specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

Claim investigator vs claim specialist salary

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

	Claim Investigator	Claim Specialist
Average salary	$49,415	$43,164
Salary range	Between $37,000 And $65,000	Between $27,000 And $67,000
Highest paying City	San Francisco, CA	Newark, NJ
Highest paying state	Alaska	New Jersey
Best paying company	Health Alliance	W. R. Berkley
Best paying industry	Finance	Insurance

Differences between claim investigator and claim specialist education

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

	Claim Investigator	Claim Specialist
Most common degree	Bachelor's Degree, 61%	Bachelor's Degree, 54%
Most common major	Criminal Justice	Business
Most common college	California State University - Bakersfield	Stanford University

Claim investigator vs claim specialist demographics

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

	Claim Investigator	Claim Specialist
Average age	44	44
Gender ratio	Male, 52.5% Female, 47.5%	Male, 31.0% Female, 69.0%
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, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim investigator and claim specialist 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 specialist example responsibilities.

Assist in the streamlining of EDI process to manage workflow of EDI claims.
Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
Manage expedition of appeals via problem solving and collaboration with other departments.

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Claim investigator vs claim specialist skills

Common claim investigator skills

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

Common claim specialist skills

Customer Service, 19%
Litigation, 7%
Patients, 5%
Claims Handling, 4%
Quality Standards, 4%
Excellent Organizational, 4%

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Updated January 8, 2025

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