Claims adjudicator vs claims director

The differences between claims adjudicators and claims directors 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 director. Additionally, a claims director has an average salary of $118,250, 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 director are customer service, litigation, and oversight.

Claims adjudicator vs claims director overview

	Claims Adjudicator	Claims Director
Yearly salary	$44,556	$118,250
Hourly rate	$21.42	$56.85
Growth rate	-6%	-6%
Number of jobs	12,413	13,299
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 68%
Average age	44	44
Years of experience	6	6

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 director do?

A claims director spearheads and oversees the daily operations of an insurance company's claims department. They have the authority to make decisions and changes, set goals and timelines, establish guidelines and budgets, liaise with key external partners, coordinate managers and teams, delegate responsibilities, and conduct research and analysis to find opportunities that will optimize the department's operations. Moreover, a claims director leads and encourages staff to reach goals, all while implementing the company's claims policies and regulations, developing new ones as needed.

Claims adjudicator vs claims director salary

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

	Claims Adjudicator	Claims Director
Average salary	$44,556	$118,250
Salary range	Between $31,000 And $63,000	Between $73,000 And $190,000
Highest paying City	Madison, WI	-
Highest paying state	New Jersey	-
Best paying company	Evolent Health	-
Best paying industry	Insurance	-

Differences between claims adjudicator and claims director education

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

	Claims Adjudicator	Claims Director
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 68%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims adjudicator vs claims director demographics

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

	Claims Adjudicator	Claims Director
Average age	44	44
Gender ratio	Male, 23.1% Female, 76.9%	Male, 58.2% Female, 41.8%
Race ratio	Black 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, 10.7% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims adjudicator and claims director 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.

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Claims director example responsibilities.

Create project team that comply with new Medicare reporting requirements achieving successful reporting to CMS.
Maintain relationships with attorneys and manage litigation strategy; ensure strong relationships with insureds, brokers and third party administrators.
Redesign processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.
General knowledge of CPT, ICD-9, HCPCS, DRG and Medicode (UCR), bundling and unbundling.
File and respond to online arbitration matters.
Facilitate annual updates to all new and revise CPT codes assuring accurate claims payment.

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Claims adjudicator vs claims director skills

Common claims adjudicator skills

Medical Terminology, 9%
CPT, 8%
Disability Claims, 7%
Adjudicate Claims, 6%
Quality Standards, 6%
Medicaid, 5%

Common claims director skills

Customer Service, 17%
Litigation, 11%
Oversight, 9%
Coverage Issues, 6%
Claims Handling, 5%
Claims Operations, 5%

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Updated January 8, 2025

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