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Claim specialist vs verification specialist

The differences between claim specialists and verification 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 specialist and a verification specialist. Additionally, a claim specialist has an average salary of $43,164, which is higher than the $31,564 average annual salary of a verification specialist.

The top three skills for a claim specialist include customer service, litigation and patients. The most important skills for a verification specialist are customer service, patients, and data entry.

Claim specialist vs verification specialist overview

Claim SpecialistVerification Specialist
Yearly salary$43,164$31,564
Hourly rate$20.75$15.18
Growth rate-6%7%
Number of jobs29,50526,348
Job satisfaction-5
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 37%
Average age4445
Years of experience66

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 verification specialist do?

The verification specialist's primary role is to make and take calls to employers for the purpose of verifying information stated by an applicant on his/her /her job application. They manage calls inbound/outbound for education, employment, reference, and licensing verification purposes. They also maintain and keep records of all calls handled to ensure all verifications made are followed upon on time. They communicate effectively and proficiently to all parties involved in attaining verification information. Moreover, they do monthly review to quality check all data gathered for verifications.

Claim specialist vs verification specialist salary

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

Claim SpecialistVerification Specialist
Average salary$43,164$31,564
Salary rangeBetween $27,000 And $67,000Between $24,000 And $41,000
Highest paying CityNewark, NJSan Jose, CA
Highest paying stateNew JerseyCalifornia
Best paying companyW. R. BerkleyJacobs Engineering Group
Best paying industryInsuranceInsurance

Differences between claim specialist and verification specialist education

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

Claim SpecialistVerification Specialist
Most common degreeBachelor's Degree, 54%Bachelor's Degree, 37%
Most common majorBusinessBusiness
Most common collegeStanford UniversityUniversity of Pennsylvania

Claim specialist vs verification specialist demographics

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

Claim SpecialistVerification Specialist
Average age4445
Gender ratioMale, 31.0% Female, 69.0%Male, 23.9% Female, 76.1%
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, 11.2% Unknown, 3.7% Hispanic or Latino, 15.2% Asian, 7.3% White, 62.3% American Indian and Alaska Native, 0.4%
LGBT Percentage10%9%

Differences between claim specialist and verification 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

Verification specialist example responsibilities.

  • Manage the TRICARE information program by presenting information utilizing available media, group presentations, or mailings.
  • Maintain confidentiality of all patient medical information adhering to HIPPA regulations and Medicare / Medicaid policies.
  • Verify primary insurance eligibility by phone with agents or online regarding Medicaid recipients and to determine payment responsibilities to providers.
  • Verify medical coverage and benefits to providers and members, review certain ICD9 and CPT codes.
  • Verify patient effective date of insurance, including CPT and diagnosis codes and general policy information.
  • Receive extensive training on insurance plans and types, HIPAA compliance, PatientPlus programming and other workplace relate topics.
  • Show more

Claim specialist vs verification specialist skills

Common claim specialist skills
  • Customer Service, 19%
  • Litigation, 7%
  • Patients, 5%
  • Claims Handling, 4%
  • Quality Standards, 4%
  • Excellent Organizational, 4%
Common verification specialist skills
  • Customer Service, 23%
  • Patients, 18%
  • Data Entry, 13%
  • Insurance Verification, 4%
  • Medicaid, 4%
  • Verification Process, 3%

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