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Claim processor vs claims benefit specialist

The differences between claim processors and claims benefit 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 claims benefit specialist. Additionally, a claims benefit specialist has an average salary of $47,292, 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 benefit specialist are customer inquiries, appeals, and medical terminology.

Claim processor vs claims benefit specialist overview

Claim ProcessorClaims Benefit Specialist
Yearly salary$41,201$47,292
Hourly rate$19.81$22.74
Growth rate-6%-6%
Number of jobs11,54232,208
Job satisfaction--
Most common degreeBachelor's Degree, 43%Bachelor's Degree, 40%
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 benefit specialist do?

Claims and benefits specialists ensure their company's compliance with the internal and external health plan partner processes. The job requires them to be sharp, organized, and able to multitask. They recommend strategies that will improve the processes present in the current trends that they constantly evaluate. These specialists manage portfolios of claims and benefits issues and ensure that they provide the best resolutions that follow the health plan processing guidelines to impress their clients.

Claim processor vs claims benefit specialist salary

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

Claim ProcessorClaims Benefit Specialist
Average salary$41,201$47,292
Salary rangeBetween $26,000 And $62,000Between $32,000 And $68,000
Highest paying CityColumbia, MD-
Highest paying stateConnecticut-
Best paying companyNTT Data International L.L.C.-
Best paying industryInsurance-

Differences between claim processor and claims benefit specialist education

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

Claim ProcessorClaims Benefit Specialist
Most common degreeBachelor's Degree, 43%Bachelor's Degree, 40%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claim processor vs claims benefit specialist demographics

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

Claim ProcessorClaims Benefit Specialist
Average age4444
Gender ratioMale, 22.9% Female, 77.1%Male, 19.6% Female, 80.4%
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, 11.4% Unknown, 4.4% Hispanic or Latino, 16.9% Asian, 5.2% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claim processor and claims benefit specialist 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 benefit specialist example responsibilities.

  • Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
  • Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
  • Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
  • Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
  • Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
  • Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.
    • Show more

Claim processor vs claims benefit specialist 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 benefit specialist skills
  • Customer Inquiries, 11%
  • Appeals, 7%
  • Medical Terminology, 6%
  • Routine Claims, 5%
  • CPT, 4%
  • Processing Issues, 4%

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Updated January 8, 2025

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