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Claim specialist vs compliance specialist

The differences between claim specialists and compliance specialists can be seen in a few details. Each job has different responsibilities and duties. Additionally, a compliance specialist has an average salary of $57,330, 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 a compliance specialist are patients, regulatory compliance, and strong analytical.

Claim specialist vs compliance specialist overview

Claim SpecialistCompliance Specialist
Yearly salary$43,164$57,330
Hourly rate$20.75$27.56
Growth rate-6%6%
Number of jobs29,50534,610
Job satisfaction--
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 61%
Average age4446
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 a compliance specialist do?

The role of compliance specialists is to ensure that companies comply with relevant industry standards and regulations. Their duties may vary depending on the industry they work in, such as healthcare or banking. Tasks include reviewing their company's business practices to ensure they follow specific regulations, resolving compliance issues that may arise, and being up-to-date with regulatory changes. As a compliance specialist, you should have industry expertise, in-depth knowledge of regulations, and auditing skills.

Claim specialist vs compliance specialist salary

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

Claim SpecialistCompliance Specialist
Average salary$43,164$57,330
Salary rangeBetween $27,000 And $67,000Between $38,000 And $85,000
Highest paying CityNewark, NJSan Francisco, CA
Highest paying stateNew JerseyDelaware
Best paying companyW. R. BerkleyMeta
Best paying industryInsurancePharmaceutical

Differences between claim specialist and compliance specialist education

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

Claim SpecialistCompliance Specialist
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 61%
Most common majorBusinessBusiness
Most common collegeStanford UniversityHarvard University

Claim specialist vs compliance specialist demographics

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

Claim SpecialistCompliance Specialist
Average age4446
Gender ratioMale, 31.0% Female, 69.0%Male, 38.4% Female, 61.6%
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, 10.9% Unknown, 4.5% Hispanic or Latino, 15.7% Asian, 8.2% White, 59.8% American Indian and Alaska Native, 0.8%
LGBT Percentage10%12%

Differences between claim specialist and compliance 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

Compliance specialist example responsibilities.

  • Lead bi-weekly Medicaid meetings to maintain effective communication with all staff regarding AHCA updates and notifications.
  • Manage and submit regulatory permit and notification applications to USDA to import, move and release regulate plant materials.
  • Participate in OCC exam preparation and review including research and presentation of documentation to achieve compliance with federal examiner requests.
  • Access the IDX system to obtain patient billing information in order to review Medicare and Medicaid payments.
  • Develop training materials to be used company-wide for regulatory mandate continuing education; create written policy manual for ethics and compliance.
  • Perform SOX control testing and validation.
  • Show more

Claim specialist vs compliance specialist skills

Common claim specialist skills
  • Customer Service, 19%
  • Litigation, 7%
  • Patients, 5%
  • Claims Handling, 4%
  • Quality Standards, 4%
  • Excellent Organizational, 4%
Common compliance specialist skills
  • Patients, 9%
  • Regulatory Compliance, 7%
  • Strong Analytical, 5%
  • FDA, 5%
  • Customer Service, 5%
  • PowerPoint, 4%

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