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Claim specialist vs audit specialist

The differences between claim specialists and audit specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, an audit specialist has an average salary of $58,291, which is higher than the $43,164 average annual salary of a claim specialist.

The top three skills for a claim specialist include customer service, litigation and patients. The most important skills for an audit specialist are audit reports, patients, and customer service.

Claim specialist vs audit specialist overview

Claim SpecialistAudit Specialist
Yearly salary$43,164$58,291
Hourly rate$20.75$28.02
Growth rate-6%6%
Number of jobs29,50540,071
Job satisfaction--
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 55%
Average age4444
Years of experience6-

What does a claim specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

What does an audit specialist do?

An audit specialist is responsible for evaluating the reports by a professional auditor that will assist in improving the growth of the organization to achieve its goals and objectives. Audit specialists aid in the development of the company by using a systematic approach to reach the goals set by the company. Primary responsibilities include operating complex and difficult audit projects and conducting audits of control, financial, and other operating records. Also, they develop, implement distinct audit strategies, programs, and procedures for intricate assignments.

Claim specialist vs audit specialist salary

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

Claim SpecialistAudit Specialist
Average salary$43,164$58,291
Salary rangeBetween $27,000 And $67,000Between $34,000 And $99,000
Highest paying CityNewark, NJSan Francisco, CA
Highest paying stateNew JerseyCalifornia
Best paying companyW. R. BerkleySAP
Best paying industryInsuranceProfessional

Differences between claim specialist and audit specialist education

There are a few differences between a claim specialist and an audit specialist in terms of educational background:

Claim SpecialistAudit Specialist
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 55%
Most common majorBusinessBusiness
Most common collegeStanford UniversityUniversity of Pennsylvania

Claim specialist vs audit specialist demographics

Here are the differences between claim specialists' and audit specialists' demographics:

Claim SpecialistAudit Specialist
Average age4444
Gender ratioMale, 31.0% Female, 69.0%Male, 33.7% Female, 66.3%
Race ratioBlack or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%Black or African American, 8.7% Unknown, 4.0% Hispanic or Latino, 11.1% Asian, 12.1% White, 63.6% American Indian and Alaska Native, 0.5%
LGBT Percentage10%7%

Differences between claim specialist and audit specialist duties and responsibilities

Claim specialist example responsibilities.

  • Assist in the streamlining of EDI process to manage workflow of EDI claims.
  • Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
  • Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
  • Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
  • Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
  • Manage expedition of appeals via problem solving and collaboration with other departments.
  • Show more

Audit specialist example responsibilities.

  • Manage vendor billing disputes for southwestern region from initiation to documentation of resolution while ensuring compliance with SOX guidelines.
  • Work with department analyst to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results.
  • Review and verify the submitted documentation for completeness to verify the company is in compliance with Sarbanes-Oxley (SOX).
  • Coordinate delivery of mortgage back securities with internal and external stakeholders.
  • Monitor and maintain automated report generation and distribution via Cognos NoticeCast.
  • Prepare monthly incentive payment and quarterly incentive bonus data for payroll department.
  • Show more

Claim specialist vs audit specialist skills

Common claim specialist skills
  • Customer Service, 19%
  • Litigation, 7%
  • Patients, 5%
  • Claims Handling, 4%
  • Quality Standards, 4%
  • Excellent Organizational, 4%
Common audit specialist skills
  • Audit Reports, 11%
  • Patients, 8%
  • Customer Service, 7%
  • Internal Audit, 6%
  • Audit Findings, 5%
  • Process Improvement, 4%

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