Claims adjudicator vs senior claims analyst

The differences between claims adjudicators and senior 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 senior claims analyst. Additionally, a senior claims analyst has an average salary of $79,886, 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 senior claims analyst are customer service, litigation, and medical terminology.

Claims adjudicator vs senior claims analyst overview

	Claims Adjudicator	Senior Claims Analyst
Yearly salary	$44,556	$79,886
Hourly rate	$21.42	$38.41
Growth rate	-6%	-6%
Number of jobs	12,413	21,159
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 61%
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 senior claims analyst do?

Senior Claims Analysts are responsible for providing support and oversight on the process of liability claims. Their duties include verifying submitted claims, assessing reimbursement policies, performing reconciliation with claims estimates, and conducting payment negotiations. They manage claims processing costs, prepare payment documents, reclassify entries, and attend to requestors' queries. Senior Claims Analyst also organizes records and assist in providing mentorship and training sessions to junior staff.

Claims adjudicator vs senior claims analyst salary

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

	Claims Adjudicator	Senior Claims Analyst
Average salary	$44,556	$79,886
Salary range	Between $31,000 And $63,000	Between $52,000 And $122,000
Highest paying City	Madison, WI	San Leandro, CA
Highest paying state	New Jersey	Hawaii
Best paying company	Evolent Health	Alameda Health System
Best paying industry	Insurance	Finance

Differences between claims adjudicator and senior claims analyst education

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

	Claims Adjudicator	Senior Claims Analyst
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 61%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims adjudicator vs senior claims analyst demographics

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

	Claims Adjudicator	Senior Claims Analyst
Average age	44	44
Gender ratio	Male, 23.1% Female, 76.9%	Male, 30.8% Female, 69.2%
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, 11.3% Unknown, 4.4% Hispanic or Latino, 16.7% Asian, 5.2% White, 62.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims adjudicator and senior 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.

Senior claims analyst example responsibilities.

Accomplish facets and Macess user including running reports.
Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
Coordinate the maintenance of TPA payment type / code table conversions data.
Process claims, generate checks, create reports and correspond with TPA clients.
Review claims for correct billing information such as correct CPT codes, ICD code and patient information.
Analyze, evaluate, and conduct statistical data reviews as required by CMS in accordance with ZPIC policies.

Claims adjudicator vs senior claims analyst skills

Common claims adjudicator skills

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

Common senior claims analyst skills

Customer Service, 7%
Litigation, 7%
Medical Terminology, 6%
Coverage Issues, 6%
Policy Provisions, 5%
Medicaid, 5%

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Claims Adjudicator
Claims Adjudicator vs Senior Claims Analyst

Updated January 8, 2025

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