Claims analyst vs senior claims specialist

The differences between claims analysts and senior claims 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 senior claims specialist. Additionally, a senior claims specialist has an average salary of $69,808, which is higher than the $48,398 average annual salary of a claims analyst.

The top three skills for a claims analyst include customer service, medical terminology and CPT. The most important skills for a senior claims specialist are customer service, litigation, and claims handling.

Claims analyst vs senior claims specialist overview

	Claims Analyst	Senior Claims Specialist
Yearly salary	$48,398	$69,808
Hourly rate	$23.27	$33.56
Growth rate	-6%	-6%
Number of jobs	22,062	11,011
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 65%
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 senior claims specialist do?

A senior claims specialist's role is to handle and process insurance claims, ensuring accuracy and smooth workflow. Their responsibilities include liaising with clients to identify their needs, reviewing and validating documentation, resolving issues and concerns, and traveling to different locations in order to perform claims inspections and investigations for client eligibility. They may also approve claims applications and negotiate settlements. Furthermore, as a senior claims specialist, it is essential to lead and serve as a mentor to junior specialists, all while implementing the company's policies and regulations.

Claims analyst vs senior claims specialist salary

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

	Claims Analyst	Senior Claims Specialist
Average salary	$48,398	$69,808
Salary range	Between $29,000 And $78,000	Between $45,000 And $107,000
Highest paying City	Trenton, NJ	-
Highest paying state	New Jersey	-
Best paying company	Google	-
Best paying industry	-	-

Differences between claims analyst and senior claims specialist education

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

	Claims Analyst	Senior Claims Specialist
Most common degree	Bachelor's Degree, 52%	Bachelor's Degree, 65%
Most common major	Business	Business
Most common college	Stanford University	Stanford University

Claims analyst vs senior claims specialist demographics

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

	Claims Analyst	Senior Claims Specialist
Average age	44	44
Gender ratio	Male, 27.6% Female, 72.4%	Male, 40.7% Female, 59.3%
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, 12.0% Unknown, 4.4% Hispanic or Latino, 16.8% Asian, 5.2% White, 61.0% American Indian and Alaska Native, 0.5%
LGBT Percentage	10%	10%

Differences between claims analyst and senior claims 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.

Senior claims specialist example responsibilities.

Manage assigned third party administration (TPA) multi-jurisdictional workers' compensation; subrogation recovery claims; assign defense attorney.
Work toward settlement with claimants and attorneys, or determine company litigation strategy, participating in mediation and arbitration when necessary.
Maintain EDI processing table logic.
Work with testing HIPAA transactions, reporting and processing data reporting to the state.
Review data entry of claims receive through the EDI system for accuracy prior to processing.
Operate within all company regulations regarding HIPAA, fraud, confidentiality, and private health information guidelines.

Claims analyst vs senior claims specialist skills

Common claims analyst skills

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

Common senior claims specialist skills

Customer Service, 26%
Litigation, 10%
Claims Handling, 8%
SR, 5%
Settlement Conferences, 5%
Excellent Interpersonal, 4%

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Claims Analyst vs Senior Claims Specialist

Updated January 8, 2025

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