Claims associate vs medical claims processor

The differences between claims associates and medical claims processors can be seen in a few details. Each job has different responsibilities and duties. It typically takes 2-4 years to become both a claims associate and a medical claims processor. Additionally, a medical claims processor has an average salary of $36,777, 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 medical claims processor are patients, healthcare, and data entry.

Claims associate vs medical claims processor overview

	Claims Associate	Medical Claims Processor
Yearly salary	$36,558	$36,777
Hourly rate	$17.58	$17.68
Growth rate	-3%	-3%
Number of jobs	9,145	59,992
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 48%	Bachelor's Degree, 29%
Average age	44	44
Years of experience	4	4

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 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 associate vs medical claims processor salary

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

	Claims Associate	Medical Claims Processor
Average salary	$36,558	$36,777
Salary range	Between $30,000 And $44,000	Between $29,000 And $45,000
Highest paying City	Hartford, CT	Dover, DE
Highest paying state	Connecticut	Delaware
Best paying company	Accenture	Cognizant
Best paying industry	Insurance	Government

Differences between claims associate and medical claims processor education

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

	Claims Associate	Medical Claims Processor
Most common degree	Bachelor's Degree, 48%	Bachelor's Degree, 29%
Most common major	Business	Business
Most common college	-	-

Claims associate vs medical claims processor demographics

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

	Claims Associate	Medical Claims Processor
Average age	44	44
Gender ratio	Male, 30.3% Female, 69.7%	Male, 16.0% Female, 84.0%
Race ratio	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%	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	11%	11%

Differences between claims associate and medical claims processor 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.

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 associate vs medical claims processor skills

Common claims associate skills

Customer Service, 14%
Medical Claims, 8%
Phone Calls, 8%
Claims Handling, 7%
Insurance Claims, 6%
Medical Terminology, 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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Office and Administrative Industry
Claims Associate
Claims Associate vs Medical Claims Processor

Updated January 8, 2025

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