Claims analyst vs medical claims examiner

The differences between claims analysts and medical claims examiners 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 examiner. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $42,773 average annual salary of a medical claims examiner.

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

Claims analyst vs medical claims examiner overview

	Claims Analyst	Medical Claims Examiner
Yearly salary	$48,398	$42,773
Hourly rate	$23.27	$20.56
Growth rate	-6%	-6%
Number of jobs	22,062	57,125
Job satisfaction	-	5
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 examiner do?

A medical claims examiner determines whether an insurer will be covering losses from accidents and illness. They are responsible for evaluating insurance claims and applications, following up with insurance adjusters to protect an insurer from financial loss, ensuring information integrity, and ensuring standard guidelines are adhered to. They are also tasked with approving payment and facilitating additional investigation. Qualifications for this position include knowledge of medical terminology.

Claims analyst vs medical claims examiner salary

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

	Claims Analyst	Medical Claims Examiner
Average salary	$48,398	$42,773
Salary range	Between $29,000 And $78,000	Between $30,000 And $59,000
Highest paying City	Trenton, NJ	Los Angeles, CA
Highest paying state	New Jersey	New Jersey
Best paying company	Google	UST Global
Best paying industry	-	Technology

Differences between claims analyst and medical claims examiner education

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

	Claims Analyst	Medical Claims Examiner
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 examiner demographics

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

	Claims Analyst	Medical Claims Examiner
Average age	44	44
Gender ratio	Male, 27.6% Female, 72.4%	Male, 16.6% Female, 83.4%
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, 10.5% Unknown, 4.4% Hispanic or Latino, 17.0% Asian, 5.3% White, 62.4% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims analyst and medical claims examiner 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 examiner example responsibilities.

Manage cases by aggressively directing the litigation process.
Process medical facility claims payment according to account-specific contract (HMO, PPO, EPO, etc . )
Process PPO, HMO, comprehensive plans, including medicare supplements, hospital, chiropractic and physical therapy claims.
Identify which claims are eligible for PPO reprising.
Resolve medical claims by approving and/or denying base on CMS guidelines for Medicaid/Medicare claim processing.
Verify that all ICD-9, CPT, modifiers and revenue codes are used correctly, prior to payment approval.

Claims analyst vs medical claims examiner skills

Common claims analyst skills

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

Common medical claims examiner skills

Medical Terminology, 10%
Customer Service, 9%
Data Entry, 7%
Medical Treatment, 5%
Computer System, 5%
Provider Contracts, 4%

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Claims Analyst vs Medical Claims Examiner

Updated January 8, 2025

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