Claim processor vs reimbursement specialist

The differences between claim processors and reimbursement specialists 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 reimbursement specialist takes usually requires 6-12 months. Additionally, a claim processor has an average salary of $41,201, which is higher than the $38,273 average annual salary of a reimbursement specialist.

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

Claim processor vs reimbursement specialist overview

	Claim Processor	Reimbursement Specialist
Yearly salary	$41,201	$38,273
Hourly rate	$19.81	$18.40
Growth rate	-6%	11%
Number of jobs	11,542	32,292
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 40%
Average age	44	45
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 reimbursement specialist do?

A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.

Claim processor vs reimbursement specialist salary

Claim processors and reimbursement specialists have different pay scales, as shown below.

	Claim Processor	Reimbursement Specialist
Average salary	$41,201	$38,273
Salary range	Between $26,000 And $62,000	Between $29,000 And $49,000
Highest paying City	Columbia, MD	Lynchburg, VA
Highest paying state	Connecticut	Virginia
Best paying company	NTT Data International L.L.C.	Novartis
Best paying industry	Insurance	Pharmaceutical

Differences between claim processor and reimbursement specialist education

There are a few differences between a claim processor and a reimbursement specialist in terms of educational background:

	Claim Processor	Reimbursement Specialist
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claim processor vs reimbursement specialist demographics

Here are the differences between claim processors' and reimbursement specialists' demographics:

	Claim Processor	Reimbursement Specialist
Average age	44	45
Gender ratio	Male, 22.9% Female, 77.1%	Male, 15.2% Female, 84.8%
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, 9.8% Unknown, 4.2% Hispanic or Latino, 16.9% Asian, 8.1% White, 59.8% American Indian and Alaska Native, 1.3%
LGBT Percentage	10%	9%

Differences between claim processor and reimbursement specialist 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.

Reimbursement specialist example responsibilities.

Manage the EDI clearinghouse rejections.
Process department payroll, order supplies, and manage petty-cash funds.
Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
Manage cases by aggressively directing the litigation process.
Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.

Claim processor vs reimbursement specialist skills

Common claim processor skills

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

Common reimbursement specialist skills

Patients, 20%
Customer Service, 9%
Appeals, 6%
CPT, 5%
Medicare, 4%
Medicaid, 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 Reimbursement Specialist

Updated January 8, 2025

Browse business and financial jobs