Claims analyst vs claims benefit specialist

The differences between claims analysts and claims benefit 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 claims analyst and a claims benefit specialist. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $47,292 average annual salary of a claims benefit specialist.

The top three skills for a claims analyst include customer service, medical terminology and CPT. The most important skills for a claims benefit specialist are customer inquiries, appeals, and medical terminology.

Claims analyst vs claims benefit specialist overview

	Claims Analyst	Claims Benefit Specialist
Yearly salary	$48,398	$47,292
Hourly rate	$23.27	$22.74
Growth rate	-6%	-6%
Number of jobs	22,062	32,208
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 40%
Average age	44	44
Years of experience	6	6

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.

What does a claims benefit specialist do?

Claims and benefits specialists ensure their company's compliance with the internal and external health plan partner processes. The job requires them to be sharp, organized, and able to multitask. They recommend strategies that will improve the processes present in the current trends that they constantly evaluate. These specialists manage portfolios of claims and benefits issues and ensure that they provide the best resolutions that follow the health plan processing guidelines to impress their clients.

Claims analyst vs claims benefit specialist salary

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

	Claims Analyst	Claims Benefit Specialist
Average salary	$48,398	$47,292
Salary range	Between $29,000 And $78,000	Between $32,000 And $68,000
Highest paying City	Trenton, NJ	-
Highest paying state	New Jersey	-
Best paying company	Google	-
Best paying industry	-	-

Differences between claims analyst and claims benefit specialist education

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

	Claims Analyst	Claims Benefit Specialist
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 40%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims analyst vs claims benefit specialist demographics

Here are the differences between claims analysts' and claims benefit specialists' demographics:

	Claims Analyst	Claims Benefit Specialist
Average age	44	44
Gender ratio	Male, 27.6% Female, 72.4%	Male, 19.6% Female, 80.4%
Race ratio	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%	Black or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.9% Asian, 5.2% White, 61.6% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims analyst and claims benefit specialist duties and responsibilities

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.

Claims benefit specialist example responsibilities.

Analyze, process and manage FMLA claims to determine eligibility and certification in compliance with state and federal regulations.
Establish a working knowledge of CPT, ICD-9, HCPCS codes, terminology, member benefits and claim flow.
Process claims utilizing appropriate ICD-9, DSM-IV and HCPCS codes.
Analyze each claim and calculate percentages for both PPO and NON-PPO providers.
Understand CPT, HCPCS, ICD-9-CM and ICD-10-CM medical claims coding regulations and guidelines
Process Non-HMO and PPO paper and electronic claims in an accurate and time manner.

Claims analyst vs claims benefit specialist skills

Common claims analyst skills

Customer Service, 14%
Medical Terminology, 5%
CPT, 5%
Process Claims, 5%
Medicaid, 5%
Data Entry, 5%

Common claims benefit specialist skills

Customer Inquiries, 11%
Appeals, 7%
Medical Terminology, 6%
Routine Claims, 5%
CPT, 4%
Processing Issues, 4%

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Claims Analyst
Claims Analyst vs Claims Benefit Specialist

Updated January 8, 2025

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