Claims analyst vs medical claims analyst

The differences between claims analysts and medical 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 analyst and a medical claims analyst. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $46,708 average annual salary of a medical claims analyst.

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

Claims analyst vs medical claims analyst overview

	Claims Analyst	Medical Claims Analyst
Yearly salary	$48,398	$46,708
Hourly rate	$23.27	$22.46
Growth rate	-6%	-6%
Number of jobs	22,062	65,897
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 36%
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 medical claims analyst do?

A medical claims analyst audits or verifies medical claims in insurance companies. Medical claims analysts make sure that corporate reimbursement payments are accurate. Usually, they work at an office on a computer workstation. They receive Medicaid claims from specialty and medical providers for reimbursement. Their job includes the development of an enhanced procedure in handling difficult Medicare/Medicaid letters while complying with the set policies.

Claims analyst vs medical claims analyst salary

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

	Claims Analyst	Medical Claims Analyst
Average salary	$48,398	$46,708
Salary range	Between $29,000 And $78,000	Between $32,000 And $68,000
Highest paying City	Trenton, NJ	Bridgewater, NJ
Highest paying state	New Jersey	New Jersey
Best paying company	Google	Montefiore Mount Vernon Hospital
Best paying industry	-	Insurance

Differences between claims analyst and medical claims analyst education

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

	Claims Analyst	Medical Claims Analyst
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 36%
Most common major	Business	Business
Most common college	Stanford University	University of Pennsylvania

Claims analyst vs medical claims analyst demographics

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

	Claims Analyst	Medical Claims Analyst
Average age	44	44
Gender ratio	Male, 27.6% Female, 72.4%	Male, 14.2% Female, 85.8%
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, 11.2% Unknown, 4.4% Hispanic or Latino, 16.4% Asian, 5.1% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims analyst and medical claims analyst 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.

Medical claims analyst example responsibilities.

Manage cases by aggressively directing the litigation process.
Analyze incoming medical claims using ICD-9, CPT, HCPCS coding, and Medicare fee schedules.
Determine if claims are in compliance under patient benefit plans for payments using DRG regulations :
Review medical records to determine if the ICD-9, CPT codes and modifiers are processed correctly.
Adhere to the HIPAA privacy, security regulations, and maintain confidentiality of patient a business records.
Research medical claims issues in response to informational inquiries by accessing and interpreting EOB's and claims history.

Claims analyst vs medical claims analyst skills

Common claims analyst skills

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

Common medical claims analyst skills

Medical Terminology, 9%
Medicaid, 6%
Medical Insurance Claims, 6%
Customer Service, 6%
Data Entry, 6%
Patients, 5%

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Claims Analyst
Claims Analyst vs Medical Claims Analyst

Updated January 8, 2025

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