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Claims associate vs claim specialist

The differences between claims associates and claim specialists can be seen in a few details. Each job has different responsibilities and duties. While it typically takes 2-4 years to become a claims associate, becoming a claim specialist takes usually requires 4-6 years. Additionally, a claim specialist has an average salary of $43,164, which is higher than the $36,558 average annual salary of a claims associate.

The top three skills for a claims associate include customer service, medical claims and phone calls. The most important skills for a claim specialist are customer service, litigation, and patients.

Claims associate vs claim specialist overview

Claims AssociateClaim Specialist
Yearly salary$36,558$43,164
Hourly rate$17.58$20.75
Growth rate-3%-6%
Number of jobs9,14529,505
Job satisfaction--
Most common degreeBachelor's Degree, 48%Bachelor's Degree, 54%
Average age4444
Years of experience46

What does a claims associate do?

Claims associates control claims for insurance companies. Their job duties include determining a customer's insurance coverage and evaluating those who have filed a claim. Also, they must make sure that a claim is analyzed correctly for the clients to receive their entitled financial settlement. The work may require the agent to travel to generate information about the claim and may vary from a different position in the insurance industry. Qualifications for the job include an associate degree, excellent interpersonal and research skills as well as relevant experience in customer service.

What does a claim specialist do?

A claims specialist is responsible for processing insurance claims, reviewing insurance coverage, and analyzing claims cases. Claims specialists' duties include negotiating claims settlements, validating claims to prevent fraud, creating court testimonies as needed, developing claim review plans, and checking necessary documents and related resolve claims. A claims specialist must have strong analytical and critical-thinking skills to authorize claim payment and investigate complex and unusual claims. Claims specialists should also have extensive knowledge of the insurance processes to handle various cases, following legal policies and regulatory procedures.

Claims associate vs claim specialist salary

Claims associates and claim specialists have different pay scales, as shown below.

Claims AssociateClaim Specialist
Average salary$36,558$43,164
Salary rangeBetween $30,000 And $44,000Between $27,000 And $67,000
Highest paying CityHartford, CTNewark, NJ
Highest paying stateConnecticutNew Jersey
Best paying companyAccentureW. R. Berkley
Best paying industryInsuranceInsurance

Differences between claims associate and claim specialist education

There are a few differences between a claims associate and a claim specialist in terms of educational background:

Claims AssociateClaim Specialist
Most common degreeBachelor's Degree, 48%Bachelor's Degree, 54%
Most common majorBusinessBusiness
Most common college-Stanford University

Claims associate vs claim specialist demographics

Here are the differences between claims associates' and claim specialists' demographics:

Claims AssociateClaim Specialist
Average age4444
Gender ratioMale, 30.3% Female, 69.7%Male, 31.0% Female, 69.0%
Race ratioBlack 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%Black or African American, 11.4% Unknown, 4.4% Hispanic or Latino, 16.5% Asian, 5.1% White, 62.1% American Indian and Alaska Native, 0.5%
LGBT Percentage11%10%

Differences between claims associate and claim specialist duties and responsibilities

Claims associate example responsibilities.

  • Investigate, evaluate, and manage call to complete coverage analysis confirming or denying coverage using Xactimate estimating software.
  • Obtain vehicle information from the DMV.
  • Follow HIPAA policy on each and every call.
  • Abided by the laws and regulations associate under HIPAA and patient confidentiality.
  • Receive recognition for creating a workflow and database for all incoming subpoenas.
  • Assist in training new CSA s on job responsibilities, which increase office productivity.
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Claim specialist example responsibilities.

  • Assist in the streamlining of EDI process to manage workflow of EDI claims.
  • Manage claims on desk, route/queues, and ECHS within specify turn-around-time parameters.
  • Manage claims, route/queues, and ECHS, within specify turn- around time parameters.
  • Investigate, manage, negotiate and resolve claims arising out of accidents involving automobile and homeowner policies.
  • Upgrade CPT-4 and ICD-9 coding procedures, staying in step with many manage care plans changing reimbursement schedules.
  • Manage expedition of appeals via problem solving and collaboration with other departments.
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Claims associate vs claim specialist skills

Common claims associate skills
  • Customer Service, 14%
  • Medical Claims, 8%
  • Phone Calls, 8%
  • Claims Handling, 7%
  • Insurance Claims, 6%
  • Medical Terminology, 5%
Common claim specialist skills
  • Customer Service, 19%
  • Litigation, 7%
  • Patients, 5%
  • Claims Handling, 4%
  • Quality Standards, 4%
  • Excellent Organizational, 4%

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