Claims analyst vs medical claims processor

The differences between claims analysts and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 4-6 years to become a claims analyst, becoming a medical claims processor takes usually requires 2-4 years. Additionally, a claims analyst has an average salary of $48,398, which is higher than the $36,777 average annual salary of a medical claims processor.

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

Claims analyst vs medical claims processor overview

	Claims Analyst	Medical Claims Processor
Yearly salary	$48,398	$36,777
Hourly rate	$23.27	$17.68
Growth rate	-6%	-3%
Number of jobs	22,062	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	6	4

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 processor do?

A medical claims processor has working knowledge of medical billing and coding. The qualifications for this position include knowledge of current procedural terminology (CPT) and international classification of diseases (ICD) coding systems. They are responsible for processing claims forms, adjudicating the allocation of deductibles and copays, and following through with adjudication policies to facilitate proper payment of claims.

Claims analyst vs medical claims processor salary

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

	Claims Analyst	Medical Claims Processor
Average salary	$48,398	$36,777
Salary range	Between $29,000 And $78,000	Between $29,000 And $45,000
Highest paying City	Trenton, NJ	Dover, DE
Highest paying state	New Jersey	Delaware
Best paying company	Google	Cognizant
Best paying industry	-	Government

Differences between claims analyst and medical claims processor education

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

	Claims Analyst	Medical Claims Processor
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	Stanford University	-

Claims analyst vs medical claims processor demographics

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

	Claims Analyst	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 27.6% Female, 72.4%	Male, 16.0% Female, 84.0%
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, 13.8% Unknown, 4.3% Hispanic or Latino, 14.4% Asian, 3.9% White, 63.2% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	11%

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

Enter UB 92 and 1500 HCFA medical claims into computer system manage and process insurance claims.
Manage cases by aggressively directing the litigation process.
Submit medical claims to commercial insurance companies, Medicare, and Medicaid for payment with use of ICD-9 and CPT coding.
Review and verify patient account information against insurance program specifications, analyze surgical procedures and diagnoses using CPT-4 and ICD-9 codes.
Acknowledge and enforces confidentiality in alignment with (HIPPA) guidelines.
Audit encounters and ICD-10 codes to ensure correct coding and maximum reimbursement.

Claims analyst vs medical claims processor skills

Common claims analyst skills

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

Common medical claims processor skills

Patients, 13%
Healthcare, 10%
Data Entry, 10%
Medical Insurance Claims, 9%
Medical Terminology, 6%
Customer Service, 3%

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Claims Analyst
Claims Analyst vs Medical Claims Processor

Updated January 8, 2025

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