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The differences between claim processors and claim specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a claim processor and a claim specialist. Additionally, a claim specialist has an average salary of $43,164, which is higher than the $41,201 average annual salary of a claim processor.
The top three skills for a claim processor include customer service, data entry and medical terminology. The most important skills for a claim specialist are customer service, litigation, and patients.
| Claim Processor | Claim Specialist | |
| Yearly salary | $41,201 | $43,164 |
| Hourly rate | $19.81 | $20.75 |
| Growth rate | -6% | -6% |
| Number of jobs | 11,542 | 29,505 |
| Job satisfaction | - | - |
| Most common degree | Bachelor's Degree, 43% | Bachelor's Degree, 54% |
| Average age | 44 | 44 |
| Years of experience | 6 | 6 |
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.
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 processors and claim specialists have different pay scales, as shown below.
| Claim Processor | Claim Specialist | |
| Average salary | $41,201 | $43,164 |
| Salary range | Between $26,000 And $62,000 | Between $27,000 And $67,000 |
| Highest paying City | Columbia, MD | Newark, NJ |
| Highest paying state | Connecticut | New Jersey |
| Best paying company | NTT Data International L.L.C. | W. R. Berkley |
| Best paying industry | Insurance | Insurance |
There are a few differences between a claim processor and a claim specialist in terms of educational background:
| Claim Processor | Claim Specialist | |
| Most common degree | Bachelor's Degree, 43% | Bachelor's Degree, 54% |
| Most common major | Business | Business |
| Most common college | Stanford University | Stanford University |
Here are the differences between claim processors' and claim specialists' demographics:
| Claim Processor | Claim Specialist | |
| Average age | 44 | 44 |
| Gender ratio | Male, 22.9% Female, 77.1% | Male, 31.0% Female, 69.0% |
| Race ratio | 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% | 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% |