Claim specialist vs senior claims representative

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

Claim specialist vs senior claims representative overview

	Claim Specialist	Senior Claims Representative
Yearly salary	$43,164	$54,592
Hourly rate	$20.75	$26.25
Growth rate	-6%	-6%
Number of jobs	29,505	10,995
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 54%	Bachelor's Degree, 75%
Average age	44	44
Years of experience	6	6

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 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 specialist vs senior claims representative salary

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

	Claim Specialist	Senior Claims Representative
Average salary	$43,164	$54,592
Salary range	Between $27,000 And $67,000	Between $31,000 And $94,000
Highest paying City	Newark, NJ	-
Highest paying state	New Jersey	-
Best paying company	W. R. Berkley	-
Best paying industry	Insurance	-

Differences between claim specialist and senior claims representative education

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

	Claim Specialist	Senior Claims Representative
Most common degree	Bachelor's Degree, 54%	Bachelor's Degree, 75%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claim specialist vs senior claims representative demographics

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

	Claim Specialist	Senior Claims Representative
Average age	44	44
Gender ratio	Male, 31.0% Female, 69.0%	Male, 47.3% Female, 52.7%
Race ratio	Black 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, 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 specialist and senior claims representative 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.

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 specialist vs senior claims representative skills

Common claim specialist skills

Customer Service, 19%
Litigation, 7%
Patients, 5%
Claims Handling, 4%
Quality Standards, 4%
Excellent Organizational, 4%

Common senior claims representative skills

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

Claim Specialist vs. similar jobs

Claim Specialist related careers

Claim Specialist related jobs

Claim Specialist jobs by location

Zippia Careers
Business and Financial Industry
Claim Specialist
Claim Specialist vs Senior Claims Representative

Updated January 8, 2025

Browse business and financial jobs