Claim processor vs senior claims representative

The differences between claim processors and senior claims representatives 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 representative. Additionally, a senior claims representative has an average salary of $54,592, 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 representative are customer service, claims handling, and litigation.

Claim processor vs senior claims representative overview

	Claim Processor	Senior Claims Representative
Yearly salary	$41,201	$54,592
Hourly rate	$19.81	$26.25
Growth rate	-6%	-6%
Number of jobs	11,542	10,995
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 75%
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 representative do?

A senior claims representative serves as a client's primary point of contact when processing insurance claims. Their responsibilities include meeting with clients to identify their needs, gathering and verifying documentation, conducting investigations to determine the validity of insurance claims, liaising with external parties, and negotiating the amount of compensation. Furthermore, as a senior claims representative, it is essential to lead and serve as a mentor to junior claims representatives, all while implementing the company's policies and regulations, including its vision and mission.

Claim processor vs senior claims representative salary

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

	Claim Processor	Senior Claims Representative
Average salary	$41,201	$54,592
Salary range	Between $26,000 And $62,000	Between $31,000 And $94,000
Highest paying City	Columbia, MD	-
Highest paying state	Connecticut	-
Best paying company	NTT Data International L.L.C.	-
Best paying industry	Insurance	-

Differences between claim processor and senior claims representative education

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

	Claim Processor	Senior Claims Representative
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 75%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claim processor vs senior claims representative demographics

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

	Claim Processor	Senior Claims Representative
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 47.3% Female, 52.7%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and senior claims 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.

Senior claims representative example responsibilities.

Conduct detailed interviews with physicians, prepare comprehensive written reports, retain defense counsel, and effectively manage the litigation process.
Utilize Xactimate estimating system during field inspection to properly evaluate commercial property damages.
Update computer generate claim file (s) with medical diagnoses, current CPT and ICD codes.
Analyze claims using IDC and CPT coding and negotiate settlements with attorneys, claimants, medical providers, and insureds.
Set up independent medical examinations, issue denials, attend arbitration hearings.
Coordinate and attend various mediation and arbitration hearings as well as numerous settlement hearings and conferences.

Claim processor vs senior claims 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 senior claims representative skills

Customer Service, 26%
Claims Handling, 14%
Litigation, 9%
Insurance Claims, 3%
Bodily Injury Claims, 3%
Automobile Claims, 3%

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Claim Processor vs Senior Claims Representative

Updated January 8, 2025

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