Post job

Explore jobs

Find specific jobs

Explore careers

Explore professions

Best companies

Explore companies

OverviewJobsSalarySkillsWhat They DoEducationDemographicsJob DescriptionHow To HireBest CompaniesBest StatesBest CitiesRemote JobsJob Outlook

Compare

Entry Level jobsWork From Home jobs

Claims adjudicator vs claims analyst

The differences between claims adjudicators and claims analysts can be seen in a few details. Each job has different responsibilities and duties. It typically takes 4-6 years to become both a claims adjudicator and a claims analyst. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $44,556 average annual salary of a claims adjudicator.

The top three skills for a claims adjudicator include medical terminology, CPT and disability claims. The most important skills for a claims analyst are customer service, medical terminology, and CPT.

Claims adjudicator vs claims analyst overview

Claims AdjudicatorClaims Analyst
Yearly salary$44,556$48,398
Hourly rate$21.42$23.27
Growth rate-6%-6%
Number of jobs12,41322,062
Job satisfaction--
Most common degreeBachelor's Degree, 57%Bachelor's Degree, 52%
Average age4444
Years of experience66

What does a claims adjudicator do?

Claims adjudicators determine the amount of money an insurance policy owner is entitled to receive. Other names they are known for are claims adjusters and medical bill advocates. They investigate the claims filed and decide to deny, pay, or negotiate a settlement with the policyholder themselves or their representatives. The insurance companies that hire them provide insurances for property, casualty, and liability. To do their job well, they should be organized and understand how the insurance industry works.

What does a claims analyst do?

A claims analyst specializes in processing medical insurance claims. They are primarily responsible for verifying the authenticity and eligibility of claims, analyzing the billing, communicating with policyholders, and ensuring adherence to all the policies and regulations during the entire procedure. Furthermore, a claims analyst is also in charge of administrative tasks such as keeping and updating records, reaching out and sending reports to creditors, setting appointments and schedules, processing paperwork, coordinating with key personnel, and discussing terms and necessary information to clients.

Claims adjudicator vs claims analyst salary

Claims adjudicators and claims analysts have different pay scales, as shown below.

Claims AdjudicatorClaims Analyst
Average salary$44,556$48,398
Salary rangeBetween $31,000 And $63,000Between $29,000 And $78,000
Highest paying CityMadison, WITrenton, NJ
Highest paying stateNew JerseyNew Jersey
Best paying companyEvolent HealthGoogle
Best paying industryInsurance-

Differences between claims adjudicator and claims analyst education

There are a few differences between a claims adjudicator and a claims analyst in terms of educational background:

Claims AdjudicatorClaims Analyst
Most common degreeBachelor's Degree, 57%Bachelor's Degree, 52%
Most common majorBusinessBusiness
Most common collegeStanford UniversityStanford University

Claims adjudicator vs claims analyst demographics

Here are the differences between claims adjudicators' and claims analysts' demographics:

Claims AdjudicatorClaims Analyst
Average age4444
Gender ratioMale, 23.1% Female, 76.9%Male, 27.6% Female, 72.4%
Race ratioBlack or African American, 10.5% Unknown, 4.5% Hispanic or Latino, 15.3% Asian, 6.1% White, 63.0% American Indian and Alaska Native, 0.5%Black or African American, 11.3% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.3% American Indian and Alaska Native, 0.5%
LGBT Percentage10%10%

Differences between claims adjudicator and claims analyst duties and responsibilities

Claims adjudicator example responsibilities.

  • Manage appeals and authorizations by examining information and performing necessary adjustments.
  • Handle claims processing utilizing knowledge of medical coding standards, including HCPCS, CPT, and ICD-9.
  • Calculate refunds or credit balances involving reprocessing for partial adjustments and correct the CPT and ICD-9 codes.
  • Maintain compliance with HIPAA guidelines and regulations
  • Adjudicate claims for Medicaid, Medicare, and ambulance billing.
  • Interpret and processes routine and complex claims per Medicaid industry standards.
    • Show more

Claims analyst example responsibilities.

  • Help managed meetings regarding decision making on CMS regulations.
  • Process UB's and HCFA's according to guidelines.
  • Analyze and investigate medical claims utilizing ICD-9 and CPT-4 coding.
  • Review claims (HCFA and UB) for accurate billing submission.
  • Interpret medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes for member submit claims.
  • Acquire biometrics and perform phlebotomy.
    • Show more

Claims adjudicator vs claims analyst skills

Common claims adjudicator skills
  • Medical Terminology, 9%
  • CPT, 8%
  • Disability Claims, 7%
  • Adjudicate Claims, 6%
  • Quality Standards, 6%
  • Medicaid, 5%
Common claims analyst skills
  • Customer Service, 14%
  • Medical Terminology, 5%
  • CPT, 5%
  • Process Claims, 5%
  • Medicaid, 5%
  • Data Entry, 5%

Claims Adjudicator vs. similar jobs

Claims Adjudicator related careers

Claims Adjudicator related jobs

What similar roles do

Updated January 8, 2025

Browse business and financial jobs