Claim processor vs senior claims examiner

The differences between claim processors and senior 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 senior claims examiner. Additionally, a senior claims examiner has an average salary of $50,962, 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 senior claims examiner are customer service, litigation, and property damage.

Claim processor vs senior claims examiner overview

	Claim Processor	Senior Claims Examiner
Yearly salary	$41,201	$50,962
Hourly rate	$19.81	$24.50
Growth rate	-6%	-6%
Number of jobs	11,542	10,931
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 58%
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 senior claims examiner do?

Senior claims examiners review, assess, and process the insurance claims of their clients. The examiners provide recommendations for claims-related resolution. It is their responsibility to examine and authorize the investigation of insurance claims as conducted by insurance adjusters. They check the claims and the insurance policies to ensure that all the information is right. During the settlement, they are expected to be careful in keeping the records with details of the process.

Claim processor vs senior claims examiner salary

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

	Claim Processor	Senior Claims Examiner
Average salary	$41,201	$50,962
Salary range	Between $26,000 And $62,000	Between $34,000 And $75,000
Highest paying City	Columbia, MD	Urban Honolulu, HI
Highest paying state	Connecticut	Hawaii
Best paying company	NTT Data International L.L.C.	W. R. Berkley
Best paying industry	Insurance	Finance

Differences between claim processor and senior claims examiner education

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

	Claim Processor	Senior Claims Examiner
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 58%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claim processor vs senior claims examiner demographics

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

	Claim Processor	Senior Claims Examiner
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 29.6% Female, 70.4%
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, 10.8% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and senior 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.

Senior claims examiner example responsibilities.

Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Coordinate vendor referrals for additional investigation and/or litigation management
Maintain office records of various types of complaints, conciliation, administrative decision, private litigation resolution, gather detailed information.
Ensure all HIPPA regulations are followed in the creation and release of all confidential records.
Coordinate vendor referrals for additional investigation and/or litigation management

Claim processor vs senior 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 senior claims examiner skills

Customer Service, 21%
Litigation, 11%
Property Damage, 9%
Claims Handling, 6%
TPA, 4%
Coverage Issues, 4%

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Claim Processor vs Senior Claims Examiner

Updated January 8, 2025

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