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Claim processor vs claims analyst

The differences between claim processors and claims analysts 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 claims analyst. Additionally, a claims analyst has an average salary of $48,398, 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 claims analyst are customer service, medical terminology, and CPT.

Claim processor vs claims analyst overview

Claim ProcessorClaims Analyst
Yearly salary$41,201$48,398
Hourly rate$19.81$23.27
Growth rate-6%-6%
Number of jobs11,54222,062
Job satisfaction--
Most common degreeBachelor's Degree, 43%Bachelor's Degree, 52%
Average age4444
Years of experience66

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.

What does a claims analyst do?

A claims analyst specializes in processing medical insurance claims. They are primarily responsible for verifying the authenticity and eligibility of claims, analyzing the billing, communicating with policyholders, and ensuring adherence to all the policies and regulations during the entire procedure. Furthermore, a claims analyst is also in charge of administrative tasks such as keeping and updating records, reaching out and sending reports to creditors, setting appointments and schedules, processing paperwork, coordinating with key personnel, and discussing terms and necessary information to clients.

Claim processor vs claims analyst salary

Claim processors and claims analysts have different pay scales, as shown below.

Claim ProcessorClaims Analyst
Average salary$41,201$48,398
Salary rangeBetween $26,000 And $62,000Between $29,000 And $78,000
Highest paying CityColumbia, MDTrenton, NJ
Highest paying stateConnecticutNew Jersey
Best paying companyNTT Data International L.L.C.Google
Best paying industryInsurance-

Differences between claim processor and claims analyst education

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

Claim ProcessorClaims Analyst
Most common degreeBachelor's Degree, 43%Bachelor's Degree, 52%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claim processor vs claims analyst demographics

Here are the differences between claim processors' and claims analysts' demographics:

Claim ProcessorClaims Analyst
Average age4444
Gender ratioMale, 22.9% Female, 77.1%Male, 27.6% Female, 72.4%
Race ratioBlack 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, 11.3% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claim processor and claims analyst duties and responsibilities

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.
    • Show more

Claims analyst example responsibilities.

  • Help managed meetings regarding decision making on CMS regulations.
  • Process UB's and HCFA's according to guidelines.
  • Analyze and investigate medical claims utilizing ICD-9 and CPT-4 coding.
  • Review claims (HCFA and UB) for accurate billing submission.
  • Interpret medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes for member submit claims.
  • Acquire biometrics and perform phlebotomy.
    • Show more

Claim processor vs claims analyst skills

Common claim processor skills
  • Customer Service, 20%
  • Data Entry, 8%
  • Medical Terminology, 5%
  • CPT, 5%
  • Claims Processing, 4%
  • Medical Insurance Claims, 4%
Common claims analyst skills
  • Customer Service, 14%
  • Medical Terminology, 5%
  • CPT, 5%
  • Process Claims, 5%
  • Medicaid, 5%
  • Data Entry, 5%

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Updated January 8, 2025

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