Claim processor vs senior claims specialist

The differences between claim processors and senior claims specialists 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 specialist. Additionally, a senior claims specialist has an average salary of $69,808, 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 specialist are customer service, litigation, and claims handling.

Claim processor vs senior claims specialist overview

	Claim Processor	Senior Claims Specialist
Yearly salary	$41,201	$69,808
Hourly rate	$19.81	$33.56
Growth rate	-6%	-6%
Number of jobs	11,542	11,011
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 65%
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 specialist do?

A senior claims specialist's role is to handle and process insurance claims, ensuring accuracy and smooth workflow. Their responsibilities include liaising with clients to identify their needs, reviewing and validating documentation, resolving issues and concerns, and traveling to different locations in order to perform claims inspections and investigations for client eligibility. They may also approve claims applications and negotiate settlements. Furthermore, as a senior claims specialist, it is essential to lead and serve as a mentor to junior specialists, all while implementing the company's policies and regulations.

Claim processor vs senior claims specialist salary

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

	Claim Processor	Senior Claims Specialist
Average salary	$41,201	$69,808
Salary range	Between $26,000 And $62,000	Between $45,000 And $107,000
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 specialist education

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

	Claim Processor	Senior Claims Specialist
Most common degree	Bachelor's Degree, 43%	Bachelor's Degree, 65%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claim processor vs senior claims specialist demographics

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

	Claim Processor	Senior Claims Specialist
Average age	44	44
Gender ratio	Male, 22.9% Female, 77.1%	Male, 40.7% Female, 59.3%
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, 12.0% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 61.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claim processor and senior claims 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.

Senior claims specialist example responsibilities.

Manage assigned third party administration (TPA) multi-jurisdictional workers' compensation; subrogation recovery claims; assign defense attorney.
Work toward settlement with claimants and attorneys, or determine company litigation strategy, participating in mediation and arbitration when necessary.
Maintain EDI processing table logic.
Work with testing HIPAA transactions, reporting and processing data reporting to the state.
Review data entry of claims receive through the EDI system for accuracy prior to processing.
Operate within all company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.

Claim processor vs senior claims 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 senior claims specialist skills

Customer Service, 26%
Litigation, 10%
Claims Handling, 8%
SR, 5%
Settlement Conferences, 5%
Excellent Interpersonal, 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 Senior Claims Specialist

Updated January 8, 2025

Browse business and financial jobs