Claim processor vs medical claims processor

The differences between claim processors and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 4-6 years to become a claim processor, becoming a medical claims processor takes usually requires 2-4 years. Additionally, a claim processor has an average salary of $41,201, which is higher than the $36,777 average annual salary of a medical claims 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 processor are patients, healthcare, and data entry.

Claim processor vs medical claims processor overview

	Claim Processor	Medical Claims Processor
Yearly salary	$41,201	$36,777
Hourly rate	$19.81	$17.68
Growth rate	-6%	-3%
Number of jobs	11,542	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	6	4

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 processor do?

A medical claims processor has working knowledge of medical billing and coding. The qualifications for this position include knowledge of current procedural terminology (CPT) and international classification of diseases (ICD) coding systems. They are responsible for processing claims forms, adjudicating the allocation of deductibles and copays, and following through with adjudication policies to facilitate proper payment of claims.

Claim processor vs medical claims processor salary

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

	Claim Processor	Medical Claims Processor
Average salary	$41,201	$36,777
Salary range	Between $26,000 And $62,000	Between $29,000 And $45,000
Highest paying City	Columbia, MD	Dover, DE
Highest paying state	Connecticut	Delaware
Best paying company	NTT Data International L.L.C.	Cognizant
Best paying industry	Insurance	Government

Differences between claim processor and medical claims processor education

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

	Claim Processor	Medical Claims Processor
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	Stanford University	-

Claim processor vs medical claims processor demographics

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

	Claim Processor	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 16.0% Female, 84.0%
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, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	11%

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

Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
Manage cases by aggressively directing the litigation process.
Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.

Claim processor vs medical claims processor 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 processor skills

Patients, 13%
Healthcare, 10%
Data Entry, 10%
Medical Insurance Claims, 9%
Medical Terminology, 6%
Customer Service, 3%

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Claim Processor vs Medical Claims Processor

Updated January 8, 2025

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