Claim processor vs provider services representative

The differences between claim processors and provider services representatives 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 provider services representative takes usually requires 6-12 months. Additionally, a claim processor has an average salary of $41,201, which is higher than the $33,858 average annual salary of a provider services representative.

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

Claim processor vs provider services representative overview

	Claim Processor	Provider Services Representative
Yearly salary	$41,201	$33,858
Hourly rate	$19.81	$16.28
Growth rate	-6%	-4%
Number of jobs	11,542	252,118
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 41%
Average age	44	40
Years of experience	6	12

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 provider services representative do?

A provider services representative is responsible for supporting, developing, and maintaining service relationships with involved participants, including providers, physicians, and administrators. Your duties typically include responding to direct and electronic questions from clients about rates, policies, referrals, and eligibility, handling telephone calls for the provider and member inquiries, and resolving complaints by the member and member representative. In addition, you will be assisting in collecting supporting data and documentation about the member's care. You are also expected to conduct research to be able to provide a well-informed answer to members' inquiries.

Claim processor vs provider services representative salary

Claim processors and provider services representatives have different pay scales, as shown below.

	Claim Processor	Provider Services Representative
Average salary	$41,201	$33,858
Salary range	Between $26,000 And $62,000	Between $24,000 And $46,000
Highest paying City	Columbia, MD	New York, NY
Highest paying state	Connecticut	New York
Best paying company	NTT Data International L.L.C.	Oracle
Best paying industry	Insurance	Health Care

Differences between claim processor and provider services representative education

There are a few differences between a claim processor and a provider services representative in terms of educational background:

	Claim Processor	Provider Services Representative
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 41%
Most common major	Business	Business
Most common college	Stanford University	-

Claim processor vs provider services representative demographics

Here are the differences between claim processors' and provider services representatives' demographics:

	Claim Processor	Provider Services Representative
Average age	44	40
Gender ratio	Male, 22.9% Female, 77.1%	Male, 22.2% Female, 77.8%
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, 11.5% Unknown, 5.1% Hispanic or Latino, 20.4% Asian, 6.4% White, 55.9% American Indian and Alaska Native, 0.7%
LGBT Percentage	10%	7%

Differences between claim processor and provider services representative 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.

Provider services representative example responsibilities.

Coach, evaluate and performance manage MSRs to ensure timely and accurate service to clients.
Achieve excellent customer satisfaction ratings as documented by CIGNA surveys.
Proof reading contracts in order to adjust claims according to proper DRG, ICD-9, and CPT codes.
Complete the surgery schedule and ensure all patients are aware of their financial responsibility prior to the surgery date.
Help providers with all information about CPT codes such as authorizations, restrictions, fee schedules, and correct diagnosis codes.
Register patients for surgery in computer system.

Claim processor vs provider services representative skills

Common claim processor skills

Customer Service, 20%
Data Entry, 8%
Medical Terminology, 5%
CPT, 5%
Claims Processing, 4%
Medical Insurance Claims, 4%

Common provider services representative skills

Customer Service, 24%
Data Entry, 6%
Patients, 5%
Medicaid, 5%
Health Insurance, 4%
Appeals, 3%

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 Provider Services Representative

Updated January 8, 2025

Browse business and financial jobs