Claims adjudicator vs senior claims representative

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

Claims adjudicator vs senior claims representative overview

	Claims Adjudicator	Senior Claims Representative
Yearly salary	$44,556	$54,592
Hourly rate	$21.42	$26.25
Growth rate	-6%	-6%
Number of jobs	12,413	10,995
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 75%
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 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.

Claims adjudicator vs senior claims representative salary

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

	Claims Adjudicator	Senior Claims Representative
Average salary	$44,556	$54,592
Salary range	Between $31,000 And $63,000	Between $31,000 And $94,000
Highest paying City	Madison, WI	-
Highest paying state	New Jersey	-
Best paying company	Evolent Health	-
Best paying industry	Insurance	-

Differences between claims adjudicator and senior claims representative education

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

	Claims Adjudicator	Senior Claims Representative
Most common degree	Bachelor's Degree, 57%	Bachelor's Degree, 75%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims adjudicator vs senior claims representative demographics

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

	Claims Adjudicator	Senior Claims Representative
Average age	44	44
Gender ratio	Male, 23.1% Female, 76.9%	Male, 47.3% Female, 52.7%
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, 11.2% 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 claims adjudicator and senior claims representative 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 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.

Claims adjudicator vs senior claims representative skills

Common claims adjudicator skills

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

Common senior claims representative skills

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

Claims Adjudicator vs. similar jobs

Claims Adjudicator related careers

Claims Adjudicator related jobs

What similar roles do

Zippia Careers
Business and Financial Industry
Claims Adjudicator
Claims Adjudicator vs Senior Claims Representative

Updated January 8, 2025

Browse business and financial jobs