Claim processor vs medical claims examiner

The differences between claim processors and medical claims examiners 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 examiner. Additionally, a medical claims examiner has an average salary of $42,773, 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 examiner are medical terminology, customer service, and data entry.

Claim processor vs medical claims examiner overview

	Claim Processor	Medical Claims Examiner
Yearly salary	$41,201	$42,773
Hourly rate	$19.81	$20.56
Growth rate	-6%	-6%
Number of jobs	11,542	57,125
Job satisfaction	-	5
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 examiner do?

A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to. They are also tasked with approving payment and facilitating additional investigation. Qualifications for this position include knowledge of medical terminology.

Claim processor vs medical claims examiner salary

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

	Claim Processor	Medical Claims Examiner
Average salary	$41,201	$42,773
Salary range	Between $26,000 And $62,000	Between $30,000 And $59,000
Highest paying City	Columbia, MD	Los Angeles, CA
Highest paying state	Connecticut	New Jersey
Best paying company	NTT Data International L.L.C.	UST Global
Best paying industry	Insurance	Technology

Differences between claim processor and medical claims examiner education

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

	Claim Processor	Medical Claims Examiner
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 examiner demographics

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

	Claim Processor	Medical Claims Examiner
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 16.6% Female, 83.4%
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, 10.5% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and medical claims examiner 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 examiner example responsibilities.

Manage cases by aggressively directing the litigation process.
Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
Identify which claims are eligible for PPO reprising.
Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

Claim processor vs medical claims examiner 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 examiner skills

Medical Terminology, 10%
Customer Service, 9%
Data Entry, 7%
Medical Treatment, 5%
Computer System, 5%
Provider Contracts, 4%

Claim Processor vs. similar jobs

Claim Processor related careers

Claim Processor related jobs

Claim Processor jobs by location

Zippia Careers
Business and Financial Industry
Claim Processor
Claim Processor vs Medical Claims Examiner

Updated January 8, 2025

Browse business and financial jobs