Claim processor vs medical claims analyst

The differences between claim processors and medical 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 medical claims analyst. Additionally, a medical claims analyst has an average salary of $46,708, 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 medical claims analyst are medical terminology, medicaid, and medical insurance claims.

Claim processor vs medical claims analyst overview

	Claim Processor	Medical Claims Analyst
Yearly salary	$41,201	$46,708
Hourly rate	$19.81	$22.46
Growth rate	-6%	-6%
Number of jobs	11,542	65,897
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 36%
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 medical claims analyst do?

A medical claims analyst audits or verifies medical claims in insurance companies. Medical claims analysts make sure that corporate reimbursement payments are accurate. Usually, they work at an office on a computer workstation. They receive Medicaid claims from specialty and medical providers for reimbursement. Their job includes the development of an enhanced procedure in handling difficult Medicare/Medicaid letters while complying with the set policies.

Claim processor vs medical claims analyst salary

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

	Claim Processor	Medical Claims Analyst
Average salary	$41,201	$46,708
Salary range	Between $26,000 And $62,000	Between $32,000 And $68,000
Highest paying City	Columbia, MD	Bridgewater, NJ
Highest paying state	Connecticut	New Jersey
Best paying company	NTT Data International L.L.C.	Montefiore Mount Vernon Hospital
Best paying industry	Insurance	Insurance

Differences between claim processor and medical claims analyst education

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

	Claim Processor	Medical Claims Analyst
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 36%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claim processor vs medical claims analyst demographics

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

	Claim Processor	Medical Claims Analyst
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 14.2% Female, 85.8%
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, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and medical 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.

Medical claims analyst example responsibilities.

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.

Claim processor vs medical 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 medical claims analyst skills

Medical Terminology, 9%
Medicaid, 6%
Medical Insurance Claims, 6%
Customer Service, 6%
Data Entry, 6%
Patients, 5%

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Claim Processor vs Medical Claims Analyst

Updated January 8, 2025

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