Claim processor vs claims coordinator

The differences between claim processors and claims coordinators 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 coordinator. Additionally, a claim processor has an average salary of $41,201, which is higher than the $38,620 average annual salary of a claims coordinator.

The top three skills for a claim processor include customer service, data entry and medical terminology. The most important skills for a claims coordinator are customer service, patients, and data entry.

Claim processor vs claims coordinator overview

	Claim Processor	Claims Coordinator
Yearly salary	$41,201	$38,620
Hourly rate	$19.81	$18.57
Growth rate	-6%	-6%
Number of jobs	11,542	27,332
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 48%
Average age	44	44
Years of experience	6	6

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 coordinator do?

Claims coordinators are professionals who are responsible for coordinating activities that are related to handling and processing insurance claims for an organization. These coordinators must serve as liaison officer between the organization, insurance provider, and policyholders to communicate the status and eligibility for coverage for all relevant claims. They need to ensure that billing requirements are met by reviewing insurance claims. Claims coordinators must also answer all the inquiries of their clients while making recommendations to resolve any claim issues.

Claim processor vs claims coordinator salary

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

	Claim Processor	Claims Coordinator
Average salary	$41,201	$38,620
Salary range	Between $26,000 And $62,000	Between $31,000 And $47,000
Highest paying City	Columbia, MD	Federal Way, WA
Highest paying state	Connecticut	New Jersey
Best paying company	NTT Data International L.L.C.	Xcel Energy
Best paying industry	Insurance	Finance

Differences between claim processor and claims coordinator education

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

	Claim Processor	Claims Coordinator
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 48%
Most common major	Business	Business
Most common college	Stanford University	-

Claim processor vs claims coordinator demographics

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

	Claim Processor	Claims Coordinator
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 24.6% Female, 75.4%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and claims coordinator 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.

Claims coordinator example responsibilities.

Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
Process and adjust Medicare claims, provide feedback to providers on proper CPT, ICD-9 coding for billing purposes.
Serve as point of contact for all legal issues relate to HIPAA.
Streamline audit procedures of TPA and maintain extremely high production rate which help in keeping staffing requirements lower.
Review and audit claims -Using correct CPT and DX codes -Denial reports -correct billing error, resubmitted claims for proper payment
Communicate with company management, injure workers/customers, medical providers and TPA, as necessary, regarding claim relate matters.

Claim processor vs claims coordinator 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 coordinator skills

Customer Service, 23%
Patients, 9%
Data Entry, 8%
Phone Calls, 6%
Insurance Claims, 5%
Quality Standards, 4%

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Claim Processor vs Claims Coordinator

Updated January 8, 2025

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